. A nurse is preparing to administer filgrastim 5 mcg/kg/day subcutaneous to a client who weighs 143 lb. How many mcg should the nurse administer per day? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) _mcg

A) Black stools: While black stools can be a potential side effect of gastrointestinal bleeding, it is not commonly associated with high-dose metoclopramide. This side effect is more commonly seen with medications such as aspirin or NSAIDs. Therefore, it is not the most pertinent adverse effect to monitor for with high-dose metoclopramide.

B) Dry cough: Dry cough is not a typical adverse effect of metoclopramide. Cough is more commonly associated with medications such as ACE inhibitors. Therefore, it is not the primary adverse effect to monitor for with high-dose metoclopramide.

C) Oral candidiasis: While oral candidiasis (oral thrush) can occur as a side effect of some medications, it is not commonly associated with metoclopramide. Oral candidiasis is more frequently seen with corticosteroids or antibiotics. Therefore, it is not the primary adverse effect to monitor for with high-dose metoclopramide.

D) Tardive dyskinesia: Tardive dyskinesia is a serious adverse effect associated with prolonged use of edicaopramide, especially at high doses. It is characterized by involuntary, repetitive movements of the face, tongue, or other parts of the body. Monitoring for signs and symptoms of tardive dyskinesia, such as repetitive facial grimacing or tongue protrusion, is crucial when administering high-dose metoclopramide to prevent this potentially irreversible condition. Therefore, this is the correct adverse effect to monitor for in clients receiving high-dose metoclopramide.

Lansoprazole: Lansoprazole is a proton pump inhibitor commonly used to reduce stomach acid production and treat conditions like gastroesophageal reflux disease (GERD) and ulcers. There are no significant contraindications or interactions between lansoprazole and nitroglycerin. Therefore, it is not contraindicated for use with nitroglycerin.

B) Diazepam: Diazepam is a benzodiazepine medication used to treat anxiety, muscle spasms, and certain seizure disorders. While caution may be necessary when using diazepam concurrently with nitroglycerin due to the potential for additive hypotensive effects, it is not typically contraindicated. However, close monitoring of blood pressure and signs of hypotension is prudent when these medications are used together.

C) Sildenafil: Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor used to treat erectile dysfunction and pulmonary arterial hypertension. Concomitant use of sildenafil with nitroglycerin is contraindicated due to the risk of profound hypotension, which can result in cardiovascular collapse. Both medications have vasodilatory effects, and their combination can lead to severe hypotension, syncope, and even myocardial infarction. Therefore, sildenafil is contraindicated for use with nitroglycerin.

D) Gemfibrozil: Gemfibrozil is a lipid-lowering medication used to reduce triglyceride levels in individuals with hypertriglyceridemia. There are no significant contraindications or interactions between gemfibrozil and nitroglycerin. Therefore, it is not contraindicated for use with nitroglycerin.