Final answer:
The correct action for a nurse when a patient receiving corticosteroids and scheduled for nivolumab reports worsening watery diarrhea and abdominal cramping is to request the physician to withhold the scheduled dose of nivolumab and conduct a complete assessment of the patient's symptoms. The final answer to the multiple-choice question is: A. Requests the physician to withhold the scheduled dose of nivolumab.
Step-by-step explanation:
When a patient reports watery diarrhea and significant abdominal cramping, especially when these symptoms have been worsening over the last three days, it is a matter of concern. In the context of a patient receiving corticosteroids and scheduled for a fifth dose of nivolumab, these symptoms could represent a potential immune-related adverse event (irAE). It is well-established that immune checkpoint inhibitors, such as nivolumab, can induce gastrointestinal irAEs, which can range from mild to severe colitis.
The nurse's priority in this scenario is to ensure the patient's safety by addressing the adverse effects. Since nivolumab may exacerbate these symptoms or indicate an underlying complication, the appropriate action is to hold the dose and promptly report the symptoms to the physician. Therefore, A. Requests the physician to withhold the scheduled dose of nivolumab is the most suitable action to take. A complete assessment should be performed, which may include a stool examination for infections like C. difficile, and a discussion about the risks and benefits of continuing the treatment with the oncologist. It is important to rule out other causes and manage the symptoms effectively before proceeding with further doses of nivolumab.
Labeling these symptoms as unexpected without further evaluation may be misleading, and proceeding with the dose or reducing it without medical consultation could be harmful. Hence, options B, C, and D are not advisable before a thorough examination and physician recommendation.