How should a pediatric oncology nurse respond to a suspected chemotherapy overdose?

• A. Wait and see if symptoms develop before acting.
• B. Stop the infusion and call the pharmacist; wait for orders.
• C. Discontinue the infusion and increase hydration.
• D. Stop the infusion, assess the patient, verify drug and dose, notify the physician, initiate protocol-based supportive care, and document all actions.

Answer: (D)

When a suspected chemotherapy overdose occurs, the priority is to limit further exposure and activate a coordinated medical response. Stop the infusion immediately to prevent any more drug from entering the patient. Then quickly assess the child’s condition—check vital signs, mental status, hydration, pain, and any toxicity symptoms—and gather key information such as the drug name, dose, concentration, time of administration, and the patient’s identity. Verify these details against the medication order and MAR to catch any errors in drug, dose, or calculation.

Next, involve the physician right away to obtain orders and activate the institution’s overdose protocol. This step ensures the right antidotes, monitoring, and supportive measures are started without delay. Initiate protocol-based supportive care as indicated, which may include targeted antidotes or treatments, close monitoring, laboratory tests, hydration and diuresis if appropriate, symptom control, and other measures specified by the protocol. By following a standardized plan, care is consistent and timely across staff.

Documentation ties everything together: record what was observed, the exact actions taken, verification steps, times, and communications with the physician and pharmacy. This not only supports the patient’s safety in the moment but also informs quality improvement and legal accountability.