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Difficulty: HardHandling Hazardous and Infectious Materials

A nurse is caring for a client with a gastrostomy tube who is prescribed a scheduled dose of oral methotrexate, a hazardous antineoplastic medication. The medication is currently available in the unit's automated dispensing cabinet as solid oral tablets. Which action by the nurse demonstrates the safest handling of this hazardous material?

  1. Contact the pharmacy to request the medication be compounded and dispensed as an oral liquid suspension.Answer
  2. B
    Crush the tablets inside a heavy-duty plastic pouch at the bedside while wearing double gloves and an isolation gown.
  3. C
    Prioritize maintaining the strict administration schedule by immediately crushing the tablets in the unit's shared electronic pill crusher.
  4. D
    Delegate the task of crushing the tablets to the unlicensed assistive personnel (UAP) who is wearing an N95 respirator.

Answer

Contact the pharmacy to request the medication be compounded and dispensed as an oral liquid suspension.
Methotrexate is classified as a hazardous drug. According to NIOSH and OSHA safe handling guidelines, hazardous solid medications should never be crushed, broken, or opened on a general patient care unit. Doing so creates toxic dust that aerosolizes, risking inhalation by healthcare workers and contaminating surfaces. If a client requires a liquid formulation for a feeding tube, the nurse must contact the pharmacy to have the medication safely compounded into an oral suspension inside a ventilated biological safety cabinet.

Step-by-Step Solution

1
Identify the medication classification and safety requirements.
Methotrexate is recognized as a hazardous antineoplastic drug.
Special handling precautions are legally and ethically required by guidelines (e.g., NIOSH, OSHA) to prevent occupational exposure to hazardous drugs.
2
Assess the required route of administration against the available medication form.
The client has a gastrostomy tube, meaning the available solid tablets must be converted to a liquid form for administration.
Solid tablets cannot be administered intact through an enteral feeding tube; they must be dissolved or crushed.
3
Determine the safest method for altering the hazardous medication form.
The nurse determines that crushing hazardous drugs on the unit is inherently unsafe and contacts pharmacy.
Crushing hazardous drugs creates toxic aerosols and contaminates the environment. Pharmacy must compound liquids in a biological safety cabinet with negative pressure.

Key Concept

Safe Handling and Preparation of Hazardous Drugs (Antineoplastics)
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Topics

Handling Hazardous and Infectious Materials

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