A nurse is caring for a client who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication?

A. A client received gentamicin intermittent IV bolus over 1 hr:

While gentamicin is typically administered as an intermittent IV bolus, the rate of administration over 1 hour is not necessarily inappropriate. However, the specific institutional protocol or medication administration guidelines should be followed. If the rate of administration deviates significantly from the standard protocol or manufacturer's recommendations, it may warrant further investigation but may not necessarily require an incident report.

B. A nurse used a 25-gauge 3-inch needle to administer a heparin injection:

Using a 25-gauge 3-inch needle for heparin injection is not standard practice and may not be the most appropriate needle size for subcutaneous administration. However, it does not necessarily indicate a need for an incident report unless it resulted in harm to the client. It may prompt further education or clarification regarding appropriate needle selection for subcutaneous injections.

C. A nurse injected Demerol IM into the vastus lateralis site of an adult:

While Demerol (meperidine) is typically administered intramuscularly, the choice of the vastus lateralis site for injection in an adult may not be the most common practice, but it is an acceptable site for IM injections. Unless there are specific contraindications or adverse outcomes related to the site selection, this finding may not require an incident report. However, it could prompt a review of injection site selection guidelines or further education.

D. A client received a crushed bupropion XL tablet mixed with applesauce:

This finding indicates a need for an incident report. Bupropion XL (extended-release) tablets should not be crushed or chewed, as this can lead to rapid release and absorption of the medication, potentially causing adverse effects or toxicity. Administering crushed extended-release tablets is a medication error that warrants an incident report to document the event, assess potential harm to the client, and implement corrective actions to prevent recurrence.

A. Prepare for gastric lavage due to an extremely elevated lithium level.

This option is incorrect. A lithium level of 1.0 mEq/L is within the therapeutic range for treating bipolar disorder or other mood disorders. Gastric lavage (stomach pumping) is not indicated for this level of lithium concentration.

B. Check the client's medication record to assess whether the client has been refusing her lithium.

This option is not directly relevant to the client's current lithium level of 1.0 mEq/L. While it's important to monitor medication adherence, the client's lithium level is within the therapeutic range, so there is no immediate concern about refusal or non-adherence.

C. Administer the morning dose of lithium.

This option is correct. With a lithium level of 1.0 mEq/L, which falls within the therapeutic range for treating bipolar disorder, the nurse should proceed with administering the morning dose of lithium as prescribed. It's important to maintain therapeutic lithium levels to effectively manage the client's condition.

D. Hold the medication and assess for early manifestations of toxicity.

This option is incorrect. With a lithium level of 1.0 mEq/L, there is no indication to hold the medication or suspect early manifestations of toxicity. Monitoring for lithium toxicity is important, but it's not warranted in this scenario where the lithium level is within the therapeutic range.