A nurse in a provider's office is assessing a client who has hypothyroidism and has been taking levothyroxine for 2 months.
Which of the following statements by the client indicates a therapeutic response to the medication?

When administering heparin subcutaneously, the nurse should grasp the skin between the thumb and forefinger throughout the injection to minimize bleeding following the injection.

Choice A is wrong because Use the Z-track method to administer the medication, is not the correct answer because the Z-track method is a technique used for intramuscular injections, not subcutaneous injections.

Choice C is wrong because Aspirate the syringe prior to injecting the heparin, is not the correct answer because aspiration is not necessary when administering heparin subcutaneously.

Choice D is wrong because Gently massage the site following the injection, is not the correct answer because massaging the injection site can increase the risk of bruising and bleeding.

Filgrastim is a medication that stimulates the production of white blood cells in the bone marrow. It is used to prevent or treat neutropenia (low white blood cell count) caused by chemotherapy, bone marrow transplant, or other conditions.

According to the guidelines for filgrastim administration, the nurse should file an incident report for the following data:

d. The nurse flushed the client’s IV line with dextrose 5% in water before and after the medication was administered.
This is because filgrastim is incompatible with dextrose solutions and should not be mixed or diluted with them. Filgrastim should only be administered in normal saline (0.9% sodium chloride) solution. Flushing the IV line with dextrose 5% in water could reduce the effectiveness of filgrastim or cause adverse reactions.

The other data are not reasons to file an incident report, as they are either within the normal range or not related to filgrastim administration.

a. The client had chemotherapy 12 hr before the medication was administered.
This is not a problem, as filgrastim can be given at any time during the chemotherapy cycle, as long as it is not given within 24 hours before or after the chemotherapy dose.

b. The medication vial sat at room temperature for 2 hr before it was administered.
This is acceptable, as filgrastim can be left out at room temperature for up to 24 hours, as long as it is not exposed to direct sunlight or shaken.

c. The client’s absolute neutrophil count was 2,500/mm³ before the medication was administered.
This is within the normal range, as the normal absolute neutrophil count is between 1,500 and 8,000/mm³. Filgrastim can be given to prevent neutropenia or to increase the white blood cell count before apheresis (a procedure to collect stem cells from the blood)