A nurse is preparing to administer amlodipine to a client. Which of the following vital signs should the nurse assess before administration?

Methylergonovine is an ergot alkaloidused to manage postpartum hemorrhage by inducing firm, sustained uterine contractions. It acts directly on the uterine smooth muscle but also possesses significant vasoconstrictive properties. Because it can cause a rapid and dangerous rise in systemic vascular resistance, it is strictly contraindicated in patients with hypertensive disorders.

Rationale:

A.Lochia rubra is the normal, bloody vaginal discharge observed in the immediate postpartum period and is not a contraindication for methylergonovine. In fact, if the lochia is excessive due to uterine atony (a boggy fundus), methylergonovine is indicated to stop the bleeding. The medication helps transition the uterus to a firm state, which actually reduces the volume of lochia rubra.

B.A blood pressure of 190/110 mm Hg is a critical contraindication because methylergonovine causes systemic arterial vasoconstriction. Administering this medication to a hypertensive patient could lead to a stroke, myocardial infarction, or seizure. The nurse must withhold the dose and notify the provider, as this drug can exacerbate pre-eclampsia or chronic hypertension to life-threatening levels.

C.A distended bladder can cause the uterus to become boggy by displacing it upward and to the side, but it does not contraindicate methylergonovine. While the nurse should encourage the patient to void to allow for natural uterine contraction, the presence of a full bladder does not make the drug unsafe. Clinical priority involves emptying the bladder to accurately assess fundal tone.

D.A urinary output of 60 mL/hr is a normal physiological finding and indicates adequate renal perfusion in the postpartum patient. There is no pharmacological reason to withhold methylergonovine based on this healthy urine volume. The nurse should continue to monitor output, but 60 mL/hr suggests the patient is hemodynamically stable and capable of clearing medications through the kidneys.

Filgrastim is a granulocyte colony-stimulating factor(G-CSF) used to stimulate the production of neutrophilsand reduce the duration of neutropenia. It acts on hematopoietic cells to increase phagocytic activity, but its timing relative to cytotoxic chemotherapy is critical to prevent drug interaction.

Rationale:

A.A decreased neutrophil count is the primary indication for administering filgrastim, not a reason for an incident report. The medication is specifically intended to treat or prevent febrile neutropenia in clients undergoing myelosuppressive therapy. Finding a low absolute neutrophil count justifies the use of the growth factor to boost the client's immune defense.

B.Filgrastim vials are stable at room temperature for up to 24 hours depending on specific manufacturer guidelines. Leaving the vial out for only 2 hours does not compromise the integrity of the medication or constitute a medication error. Therefore, this action does not necessitate an incident report as the medication remains safe for administration to the client.

C.Filgrastim should not be administered within 24 hours before or after the administration of cytotoxic chemotherapy. Giving the medication only 12 hr after chemotherapy is a significant timing error that can interfere with the effectiveness of the treatment and worsen marrow suppression. The nurse must complete an incident report to document this violation of the safety protocol for colony-stimulating factors.

D.Nausea is a common side effect of chemotherapy and can also occur with filgrastim, though it is not a reason for an incident report. Incident reports are reserved for errors, accidents, or unexpected hazardous events, not for documenting known, documented adverse reactions. The nurse should manage the nausea with antiemetics rather than filing an administrative error report.