Oncology Certification Nursing ACTUAL
QUESTIONS AND CORRECT ANSWERS
infiltration - CORRECT ANSWERS passage or escape of IV administered drugs into the
tissue
extravasation - CORRECT ANSWERS leakage of drugs capable of causing tissue damage
into the subcutaneous or subdermal tissue or other unintended sites.
irritation - CORRECT ANSWERS a localized inflammatory reaction at the infusion or
injection site
flare reaction - CORRECT ANSWERS a local allergic reaction along a vein caused by
irritating drugs.
infusion reactions - CORRECT ANSWERS reactions mediated by the immune system
(hypersensitivity, anaphylaxis, cytokine release syndrome)
DNA-binding vesicants - CORRECT ANSWERS vesicant binds to nucleic acids in the
DNA of healthy cells in the tissue, causing cell death. the dead cells then release complexes,
which are taken up by adjacent healthy cells. this process causes a continuing cycle of tissue
damage as the vesicant is retained in the tissue for a long period of time.
NON-DNA binding vesicants - CORRECT ANSWERS the vesicant has an indirects effect
on healthy cells. it does not bind to cellular DNA. it is metabolized in the tissue and is more
easily neutralized.
cabazitaxel (jevtana) - CORRECT ANSWERS a taxane where infiltration has not caused
skin or tissue impairment
,Docetaxel (taxotere) - CORRECT ANSWERS extravasation may cause
hyperpigmentation, erythema and tenderness.
paclitaxel (taxol) - CORRECT ANSWERS injection site reactions, including reactions
secondary to extravasation, usually mild and consist of erythema, tenderness, skin
hyperpigmentation or swelling at injection site. seen more often with 24 hour infusions than with
3 hour infusions. severe reactions such as phlebitis, cellulitis, induration, skin exfoliation,
necrosis and fibrosis have been reported. onset has been delayed by a week to 10 days.
recall reactions - CORRECT ANSWERS recurrence of skin reactions at the site of
previous extravasation following paclitaxel injection at a different site.
docetaxel and paclitaxel - CORRECT ANSWERS classified as exfoliants or drugs that
may cause inflammation and peeling of skin without causing underlying tissue death.
factors affecting tissue damage severity following a vesicant extravasation - CORRECT
ANSWERS 1. DNA binding vesicants cause greater tissue damage than non-dna binding
vesicants
2. the higher the concentration and greater amount of a vesicant the more damaged caused.
3. location of the extravasation such as those with little subcutaneous tissue and overlying veins,
arteries and nerves are likely to have more damage.
4. older age, comorbidity and impaired immunocompetence cause more damage.
risk factors for peripheral extravasation - CORRECT ANSWERS 1. small, fragile veins
2. previous multiple venipunctures
3. sensory deficits
4. application of topical skin numbing agents prior to venipuncture
,5. limited vein selection d/t lymph node dissection
6. impaired cognition, altered mental status or somnolence
7. probing during IV catheter insertion
8. administration site in areas prone to movement
9. use of rigid IV devices.
10. prior treatment with irritating or sclerosing drugs
11. administration of a vesicant peripherally when the manufacturer stipulates it should be
administered via a central line.
possible etiologies of peripheral extravasations - CORRECT ANSWERS 1.vein wall
puncture, piercing or trauma.
2. dislodgement of the catheter from a vein
3. administration of a vesicant in a vein below a recent venipuncture site.
4.administration of a vesicant in a vein below or recent or non-healed vesicant extravasation site.
5. inadvertent intramuscular or subcutaneous vesicant administration.
Risk factors for extravasation from central VADs - CORRECT ANSWERS 1. difficulty
encountered during device insertion
2. inadvertent slicing, piercing or nicking of catheter prior to insertion
3. device misplacement with catheter tip outside of the venous system.
4. insufficient length of non coring needle (implanted port)
5. presence of a fibrin sheath or thrombus at the catheter tip.
6.catheter migration
7. long dwell time of catheters inserted using a subclavian approach, in which the catheter is
placed between the clavicle and first rib
, possible etiologies of extravasations from central VADs - CORRECT ANSWERS 1.
inadvertent misplacement of catheter tip outside of the venous system during insertion
procedure.
2. vein perforation during insertion
3. post insertion vein erosion, catheter leakage, rupture or fracture.
4. separation of the catheter from a portal body.
5. incomplete insertion of a non coring needle into an implanted port
6. non coring needle dislodgement from an implanted port.
7. backflow of vesicant along the catheter to the venotomy site secondary to fibrin sheath or
thrombus at the catheter tip.
signs and symptoms of vesicant extravasation - CORRECT ANSWERS 1. vein irritation
and flare reactions may mimic signs of vesicant extravasation.
2. vein irritation and flare reactions only occur in peripheral chemo administration
3. if it happens in CAD it is d/t catheter tip placement outside of the venous access device or
erosion of the vein wall.
4. this may cause SOB and shock to secondary blood loss.
additional signs and symptoms of vesicant extravasation - CORRECT ANSWERS 1. IV
flow rate that slows or stops
2. resistance during IV bolus vesicant administration
3. leaking around the IV catheter or implanted port needle.
consequences of untreated vesicant extreavasation - CORRECT ANSWERS 1. blistering
(usually happens within 3 to 5 days.
2. peeling and sloughing of skin (usually begins 2 weeks after extravasation)
3. tissue necrosis (usually evident two or three weeks after extravasation.
QUESTIONS AND CORRECT ANSWERS
infiltration - CORRECT ANSWERS passage or escape of IV administered drugs into the
tissue
extravasation - CORRECT ANSWERS leakage of drugs capable of causing tissue damage
into the subcutaneous or subdermal tissue or other unintended sites.
irritation - CORRECT ANSWERS a localized inflammatory reaction at the infusion or
injection site
flare reaction - CORRECT ANSWERS a local allergic reaction along a vein caused by
irritating drugs.
infusion reactions - CORRECT ANSWERS reactions mediated by the immune system
(hypersensitivity, anaphylaxis, cytokine release syndrome)
DNA-binding vesicants - CORRECT ANSWERS vesicant binds to nucleic acids in the
DNA of healthy cells in the tissue, causing cell death. the dead cells then release complexes,
which are taken up by adjacent healthy cells. this process causes a continuing cycle of tissue
damage as the vesicant is retained in the tissue for a long period of time.
NON-DNA binding vesicants - CORRECT ANSWERS the vesicant has an indirects effect
on healthy cells. it does not bind to cellular DNA. it is metabolized in the tissue and is more
easily neutralized.
cabazitaxel (jevtana) - CORRECT ANSWERS a taxane where infiltration has not caused
skin or tissue impairment
,Docetaxel (taxotere) - CORRECT ANSWERS extravasation may cause
hyperpigmentation, erythema and tenderness.
paclitaxel (taxol) - CORRECT ANSWERS injection site reactions, including reactions
secondary to extravasation, usually mild and consist of erythema, tenderness, skin
hyperpigmentation or swelling at injection site. seen more often with 24 hour infusions than with
3 hour infusions. severe reactions such as phlebitis, cellulitis, induration, skin exfoliation,
necrosis and fibrosis have been reported. onset has been delayed by a week to 10 days.
recall reactions - CORRECT ANSWERS recurrence of skin reactions at the site of
previous extravasation following paclitaxel injection at a different site.
docetaxel and paclitaxel - CORRECT ANSWERS classified as exfoliants or drugs that
may cause inflammation and peeling of skin without causing underlying tissue death.
factors affecting tissue damage severity following a vesicant extravasation - CORRECT
ANSWERS 1. DNA binding vesicants cause greater tissue damage than non-dna binding
vesicants
2. the higher the concentration and greater amount of a vesicant the more damaged caused.
3. location of the extravasation such as those with little subcutaneous tissue and overlying veins,
arteries and nerves are likely to have more damage.
4. older age, comorbidity and impaired immunocompetence cause more damage.
risk factors for peripheral extravasation - CORRECT ANSWERS 1. small, fragile veins
2. previous multiple venipunctures
3. sensory deficits
4. application of topical skin numbing agents prior to venipuncture
,5. limited vein selection d/t lymph node dissection
6. impaired cognition, altered mental status or somnolence
7. probing during IV catheter insertion
8. administration site in areas prone to movement
9. use of rigid IV devices.
10. prior treatment with irritating or sclerosing drugs
11. administration of a vesicant peripherally when the manufacturer stipulates it should be
administered via a central line.
possible etiologies of peripheral extravasations - CORRECT ANSWERS 1.vein wall
puncture, piercing or trauma.
2. dislodgement of the catheter from a vein
3. administration of a vesicant in a vein below a recent venipuncture site.
4.administration of a vesicant in a vein below or recent or non-healed vesicant extravasation site.
5. inadvertent intramuscular or subcutaneous vesicant administration.
Risk factors for extravasation from central VADs - CORRECT ANSWERS 1. difficulty
encountered during device insertion
2. inadvertent slicing, piercing or nicking of catheter prior to insertion
3. device misplacement with catheter tip outside of the venous system.
4. insufficient length of non coring needle (implanted port)
5. presence of a fibrin sheath or thrombus at the catheter tip.
6.catheter migration
7. long dwell time of catheters inserted using a subclavian approach, in which the catheter is
placed between the clavicle and first rib
, possible etiologies of extravasations from central VADs - CORRECT ANSWERS 1.
inadvertent misplacement of catheter tip outside of the venous system during insertion
procedure.
2. vein perforation during insertion
3. post insertion vein erosion, catheter leakage, rupture or fracture.
4. separation of the catheter from a portal body.
5. incomplete insertion of a non coring needle into an implanted port
6. non coring needle dislodgement from an implanted port.
7. backflow of vesicant along the catheter to the venotomy site secondary to fibrin sheath or
thrombus at the catheter tip.
signs and symptoms of vesicant extravasation - CORRECT ANSWERS 1. vein irritation
and flare reactions may mimic signs of vesicant extravasation.
2. vein irritation and flare reactions only occur in peripheral chemo administration
3. if it happens in CAD it is d/t catheter tip placement outside of the venous access device or
erosion of the vein wall.
4. this may cause SOB and shock to secondary blood loss.
additional signs and symptoms of vesicant extravasation - CORRECT ANSWERS 1. IV
flow rate that slows or stops
2. resistance during IV bolus vesicant administration
3. leaking around the IV catheter or implanted port needle.
consequences of untreated vesicant extreavasation - CORRECT ANSWERS 1. blistering
(usually happens within 3 to 5 days.
2. peeling and sloughing of skin (usually begins 2 weeks after extravasation)
3. tissue necrosis (usually evident two or three weeks after extravasation.
