A nurse is providing teaching for a client who has a new prescription for alprazolam to treat insomnia. Which of the following instructions should the nurse include?

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. The client demonstrated an allergic response to the medication: While allergic reactions to disulfiram can occur, severe nausea and vomiting after taking the medication are more likely due to its interaction with alcohol rather than an allergic response.

B. The client consumed alcohol while taking the medication: Disulfiram is used to deter alcohol consumption by causing unpleasant reactions when alcohol is ingested. Severe nausea and vomiting are common adverse effects of consuming alcohol while on disulfiram.

C. The client took an overdose of the medication: An overdose of disulfiram could potentially lead to severe adverse effects, but nausea and vomiting alone are not typically indicative of an overdose.

D. The client experienced a common side effect of the medication: While nausea and vomiting are common side effects of disulfiram, they are typically experienced in response to alcohol consumption rather than as direct effects of the medication itself.