A nurse in a clinic is planning care for a child who has ADHD and is taking atomoxetine.
Which of the following laboratory values should the nurse monitor?

Choice A rationale:

The prescription for Levothyroxine 75 mcg PO daily at 0600 does not require clarification. It provides clear instructions for the medication, including the drug name, dosage, route, and timing. The administration time (0600) is specific, allowing the nurse to administer the medication accurately.

Choice B rationale:

The prescription for Digoxin 250 PO daily contains an error. The dosage (250) is missing the unit of measurement (e.g., mcg or mg). Without the unit, it is impossible to accurately administer the medication. This prescription needs clarification from the prescriber to ensure safe and precise administration.

Choice C rationale:

The prescription for Acetaminophen 650 mg PO Q6 hours does not require clarification. It provides clear instructions for the medication, including the drug name, dosage (650 mg), route (PO), and frequency (every 6 hours). The dosing interval is appropriate and within the normal range for acetaminophen administration.

Choice D rationale:

The prescription for Ceftriaxone 1 g IV Q 24 hours does not require clarification. It provides clear instructions for the medication, including the drug name, dosage (1 g), route (IV), and frequency (every 24 hours). The dosing interval is appropriate for this antibiotic and allows for effective treatment of infections.

The correct answer is D. Use a solution of 0.9% sodium chloride to flush the transfusion tubing.

Choice A reason: Storing a unit of blood at room temperature for 1 hour prior to the infusion is not recommended. Blood products should be kept refrigerated until just before the transfusion to minimize the risk of bacterial contamination. The recommended storage temperature for packed RBCs is 1-6°C. If blood is left at room temperature, it should be infused within 30 minutes to ensure safety.

Choice B reason: Ensuring that the transfusion is completed within 6 hours is not correct. The standard practice is to complete a blood transfusion over 2 to 4 hours, depending on the volume and the patient’s condition. This is to reduce the risk of bacterial growth and transfusion reactions. Prolonging the transfusion time beyond 4 hours increases the risk of bacterial contamination and can compromise the efficacy of the transfused red blood cells.

Choice C reason: Obtaining venous access using a 22-gauge needle is not ideal for a transfusion of packed RBCs. A larger bore needle, typically an 18-gauge or 20-gauge, is preferred to ensure adequate flow of the viscous packed RBCs and to prevent hemolysis. The smaller the gauge number, the larger the needle diameter, so a 22-gauge needle might be too small and could damage the red blood cells during the transfusion.

Choice D reason: Using a solution of 0.9% sodium chloride to flush the transfusion tubing is the correct action. Normal saline is isotonic and is the only fluid compatible with packed RBCs. It is used to prime the transfusion set and to flush the line before and after the transfusion to prevent hemolysis and clotting within the tubing.