Which of the following nursing interventions are appropriate for the management of spinal cord compression, tumor lysis syndrome, and hypercalcemia?

Choice A rationale

Cyclosporine is a lipophilic polypeptide that requires consistent administration in relation to food to ensure stable plasma concentrations. Variations in fat content within meals can significantly alter the bioavailability and absorption rate of the drug. By maintaining a consistent intake pattern, either always with food or always without, the patient avoids dangerous fluctuations in therapeutic levels. This consistency is vital to prevent graft rejection caused by subtherapeutic levels or toxicity caused by supratherapeutic levels.

Choice B rationale

Pulmonary status and coughing are not primary monitoring parameters specifically linked to the unique side effect profile of cyclosporine therapy. While general immunosuppression increases the risk of opportunistic infections like pneumonia, cyclosporine does not typically cause direct pulmonary toxicity. The nurse should focus more on renal, hepatic, and neurological assessments. Monitoring for a cough might be more relevant for patients on ACE inhibitors or those with specific fungal risks, rather than a standard cyclosporine protocol.

Choice C rationale

Nephrotoxicity is the most serious and common adverse effect of cyclosporine therapy, occurring in up to 75 percent of patients. The drug causes dose-dependent constriction of the afferent arterioles in the kidney, leading to decreased renal blood flow and a reduced glomerular filtration rate. Normal serum creatinine levels range from 0.7 to 1.3 mg/dL. The nurse must monitor for elevations in creatinine and BUN to distinguish between drug-induced renal damage and potential organ transplant rejection.

Choice D rationale

Hirsutism and gingival hyperplasia are well-documented side effects of cyclosporine that affect patient appearance and oral health. Hirsutism involves the growth of excess body hair, while gingival hyperplasia is the overgrowth of gum tissue around the teeth. These conditions can lead to significant body image distress and dental complications. The nurse should encourage meticulous oral hygiene and frequent dental checkups to manage tissue overgrowth and prevent secondary infections or tooth loss associated with these side effects.

Choice E rationale

Administering cyclosporine without food is not a mandatory requirement, but consistency is the priority. Some protocols allow for administration on an empty stomach to achieve faster peak levels, but this often causes gastrointestinal upset. The most critical factor is that the method chosen by the patient remains identical every day. Switching between taking it with a large meal and taking it on an empty stomach causes unpredictable absorption, making it difficult to maintain the narrow therapeutic window.

Choice A rationale

Extravasation of vesicant chemotherapy agents triggers immediate cellular damage and localized inflammatory responses. Stopping the infusion prevents further tissue exposure to toxic compounds that cause necrosis. Notification of the provider is essential to initiate specific antidote protocols or surgical consultation. Physical assessment determines the extent of the injury, which is critical for documentation and intervention planning. This priority action minimizes long term morbidity and functional loss at the peripheral or central venous access site.

Choice B rationale

Antiemetics are pharmacological agents used to manage chemotherapy induced nausea and vomiting by blocking neurotransmitters like serotonin or dopamine in the chemoreceptor trigger zone. While supportive care is important during oncological treatment, administering these medications does not address the acute mechanical or chemical injury occurring at the intravenous site. Continuing the infusion while the patient reports pain and swelling would exacerbate tissue destruction and potentially lead to compartment syndrome or permanent nerve damage.

Choice C rationale

Continuing a chemotherapy infusion when signs of infiltration or extravasation are present violates safety standards and increases the volume of vesicant in the interstitial space. Warm compresses are contraindicated for certain chemotherapeutic agents, such as vinca alkaloids, because heat can increase local blood flow and spread the toxic drug further into surrounding tissues. Initial management must prioritize cessation of the causative agent rather than symptom masking through thermal applications which might worsen the chemical burn.

Choice D rationale

Aspiration of residual drug from the cannula is a recognized component of extravasation management, but it must never be performed while the infusion is active. Attempting to aspirate without stopping the pump allows the machine to continue forcing fluid into the subcutaneous tissue under pressure. The sequence of nursing actions must always begin with stopping the flow of the hazardous substance to limit the radius of the injury before attempting to remove the fluid.