A nurse is assessing a client who has heart failure and is taking digoxin. Which of the following findings should the nurse identify as an early indication of medication toxicity?

Choice A Reason:
INR (International Normalized Ratio) is incorrect. INR is a measurement used to monitor the effects of anticoagulants like warfarin. It assesses the blood's ability to clot. Filgrastim does not directly affect INR levels, so monitoring INR would not provide information about the effectiveness of filgrastim in stimulating white blood cell production.
Choice B Reason:
BUN (Blood Urea Nitrogen) is incorrect. BUN levels primarily indicate kidney function and hydration status. They are not directly influenced by filgrastim treatment. Monitoring BUN is essential for assessing kidney function but does not reflect the effectiveness of filgrastim therapy in increasing white blood cell counts.
Choice C Reason:
WBC count is correct. Filgrastim is a medication that stimulates the production of white blood cells (WBCs), particularly neutrophils. Therefore, the key laboratory value to monitor for assessing the effectiveness of filgrastim therapy is the WBC count. An increase in the WBC count, particularly in the neutrophil count, signifies the intended therapeutic effect of filgrastim in boosting the immune system's response by increasing the production of these infection-fighting cells.
Choice D Reason:
Potassium level is incorrect. Potassium levels are crucial for heart and muscle function. While certain medications might affect potassium levels, filgrastim's primary action is on stimulating white blood cell production and does not directly impact potassium levels. Monitoring potassium levels is essential for overall health but does not specifically indicate the effectiveness of filgrastim treatment.

Choice A Reason:
Giving the prescribed dose of clindamycin is not appropriate due to the reported penicillin allergy, which increases the risk of an allergic reaction.
Choice B Reason:
Obtain a prescription for an alternative antibiotic is correct. Given the client's reported allergy to penicillin, which is in the same antibiotic class as clindamycin (both are antibiotics that belong to the beta-lactam group), there is a higher risk of cross-reactivity and potential allergic reaction. Therefore, it's important to avoid administering clindamycin in such cases and seek an alternative antibiotic that does not have a similar chemical structure to penicillin to prevent an allergic reaction.
Choice C Reason:
Premeditating the client with epinephrine before administering the antibiotic is not a standard practice in this context. Epinephrine is used to treat severe allergic reactions but is not used as a preventive measure before administering antibiotics.
Choice D Reason:
Administering the clindamycin using a desensitization schedule might be an option in certain situations under the guidance of an allergist or immunologist, but it's not typically performed by nurses and requires a specific protocol and expertise in managing drug allergies. Obtaining an alternative antibiotic is a more appropriate and immediate action to avoid the risk of an allergic reaction in this scenario.