A nurse is preparing to administer the initial dose of penicillin G IM to a client. The nurse should monitor for which of the following as an indication of an allergic reaction following the injection?

A. The correct order is

1. wipe off tops of insulin vials with alcohol sponge.
2. draw back amount of air into the syringe that equals total dose.
3. inject air equal to NPH dose into NPH vial. ...
4. air equal to regular dose into regular vial.
5. invert regular insulin bottle and withdraw regular insulin dose.
6. without adding more air into NPH vial, carefully withdraw NPH dose

B. Withdraw the regular insulin from the vial: This step should occur after injecting air into the regular insulin vial. The nurse should draw up the regular insulin before drawing up the NPH
insulin.

C. Inject air into the regular insulin vial: Inject air into the regular insulin vial is not thecorrect first step to avoid contamination of the clear insulin with cloudy insulin..
D. Withdraw the NPH insulin from the vial: This step should occur after withdrawing the regular insulin. The nurse should draw up the NPH insulin after drawing up the regular insulin to ensure the correct sequence and dosage.

A. The client had a decreased neutrophil count before the medication was administered: This finding may be expected in a client undergoing cytotoxic chemotherapy and receiving filgrastim to stimulate neutrophil production. It is not an indication for an incident report.
B. The client had chemotherapy 12 hr before the medication was administered: The timing of chemotherapy administration is not typically a reason to complete an incident report unless it conflicts with specific medication guidelines or protocols.
C. The vial was out of the refrigerator for 2 hr before the medication was administered:

Filgrastim should be stored in the refrigerator and protected from light. Allowing the medication vial to be out of the refrigerator for an extended period may compromise its stability and effectiveness, potentially leading to adverse effects or reduced efficacy. Therefore, this finding warrants completion of an incident report.
D. The client reported feeling nauseous after the medication was administered: Nausea is a known side effect of filgrastim and is not typically an indication for completing an incident report unless it is severe or persistent and requires intervention.