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Ifosfamide and cyclophosphamide generate the urotoxic metabolite acrolein, which can cause hemorrhagic cystitis. Standard prevention bundles include vigorous IV hydration to dilute and flush acrolein and co-administration of mesna (2-mercaptoethane sulfonate), which binds acrolein in urine and neutralizes its toxicity. Mesna is dosed proportionally to ifosfamide and administered IV or orally on schedules that ensure urinary coverage through the drug’s excretion window. For very high-dose regimens or prior cystitis, continuous bladder irrigation may be added. Antibiotics (Option C) do not prevent chemical cystitis. Loop diuretics alone (Option D) increase urine output but do not neutralize acrolein; omitting mesna is unsafe. Supplements such as cranberry (Option A) lack evidence for this indication. APRN responsibilities include verifying mesna timing relative to ifosfamide, ensuring adequate hydration orders (e.g., normal saline pre/post), monitoring urine output, urinalysis for hematuria, and educating patients to report dysuria, frequency, or clots immediately. If gross hematuria develops, hold offending agents, escalate to urology, manage clots, and consider agents like alum or prostaglandins per institution protocols.