. 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

Answer: C. Keep the solution refrigerated until 1 hr before infusion.

Rationale:

A. Change the solution every 36 hr:
Total parenteral nutrition (TPN) solutions should be changed every 24 hours to prevent contamination and bacterial growth. Therefore, changing the solution every 36 hours would not adhere to best practice guidelines.

B. Obtain the client's weight three times a week:
While monitoring the client’s weight is important, especially for those on TPN, it should be done daily to accurately assess fluid balance and nutritional status. This frequency allows for timely adjustments to the TPN regimen.

C. Keep the solution refrigerated until 1 hr before infusion:
This action is correct. TPN solutions must be refrigerated to maintain stability and prevent bacterial growth. Allowing the solution to come to room temperature for at least 1 hour before infusion helps ensure that the solution is at a safe and comfortable temperature for the client.

D. Check the client's WBC count daily:
While monitoring the WBC count can be important for detecting infection, it is not a standard daily requirement specifically related to TPN administration. The priority is to focus on monitoring the client's nutritional status and fluid balance more closely during TPN therapy

A) A client vomits after receiving an oral medication: While vomiting after medication administration should be documented in the client's medical record as it could indicate a ’otential adverse reaction or medication intolerance, it does not necessarily require an incident report unless there are unusual circumstances surrounding the event.

B) A client receives their meal tray 20 minutes before time: This situation does not require an incident report. It may be considered a minor deviation from the usual mealtime schedule, and no harm or adverse outcome is implied.

C) A client receives their insulin before scheduled time: This is the correct answer. Administering insulin before the scheduled time can pose significant risks to the client, potentially leading to hypoglycemia or other adverse effects. Such deviations from the prescribed administration time should be documented in an incident report to ensure appropriate investigation and prevention of recurrence.

D) A client experiences a seizure: While a client experiencing a seizure is a critical event that requires immediate nursing intervention and documentation, it does not typically warrant an incident report unless it occurs in unusual circumstances or if there are concerns about the client's safety or well-being during the seizur’.