A nurse is caring for a client who has chronic liver disease. Which of the following medications should the nurse recognize as appropriate for this client?

A. Hypertension. Filgrastim, a granulocyte colony-stimulating factor (G-CSF), primarily stimulates white blood cell production. While minor blood pressure fluctuations can occur, hypertension is not a common or significant adverse effect. Monitoring blood pressure is important, but sustained hypertension is not expected.

B. Fluid retention. Filgrastim does not typically cause significant fluid retention. Medications such as corticosteroids or certain chemotherapeutic agents are more likely to lead to fluid overload. While rare cases of capillary leak syndrome have been reported, general fluid retention is not a primary concern.

C. Bone pain. Bone pain is the most common adverse effect of filgrastim. The medication stimulates bone marrow activity, leading to increased production of neutrophils, which can cause discomfort in bones, particularly in long bones such as the femur and sternum. Pain is usually mild to moderate and can be managed with acetaminophen or NSAIDs if appropriate.

D. Hypokalemia. Filgrastim does not have a direct effect on potassium levels. Electrolyte imbalances are more commonly associated with diuretics, corticosteroids, or chemotherapy. Clients on filgrastim typically do not require routine potassium monitoring unless other risk factors are present.

A. Meperidine. Meperidine is an opioid analgesic used for moderate to severe pain. It does not treat nausea and vomiting and can worsen these symptoms by delaying gastric emptying. Opioids also depress the central nervous system, which may cause dizziness and sedation.

B. Diazepam. Diazepam is a benzodiazepine used for anxiety, muscle spasms, and seizures. It has no antiemetic effects and does not relieve nausea or vomiting. Instead, it can cause dizziness and drowsiness, which may further discomfort the client.

C. Naloxone. Naloxone is an opioid antagonist used to reverse opioid-induced respiratory depression. Since the client’s nausea is not opioid-related, naloxone would not be beneficial. Its administration can also cause withdrawal symptoms in opioid-dependent clients.

D. Promethazine. Promethazine is an antiemetic that blocks histamine and dopamine receptors in the brain, reducing nausea and vomiting. It is commonly used for motion sickness, post-surgical nausea, and gastrointestinal illnesses, making it the appropriate choice for this client.