A nurse recently administered filgrastim intravenously to a client who has cancer and is receiving cytotoxic chemotherapy.
For which of the following data, discovered after the medication was administered, should the nurse file an incident report?
The client had chemotherapy 12 hr before the medication was administered.
The medication vial sat at room temperature for 2 hr before it was administered.
The client's absolute neutrophil count was 2,500/mm³ before the medication was administered.
The nurse flushed the client's IV line with dextrose 5% in water before and after the medication was administered.
The Correct Answer is D
Filgrastim is a medication that stimulates the production of white blood cells in the bone marrow. It is used to prevent or treat neutropenia (low white blood cell count) caused by chemotherapy, bone marrow transplant, or other conditions.
According to the guidelines for filgrastim administration, the nurse should file an incident report for the following data:
d. The nurse flushed the client’s IV line with dextrose 5% in water before and after the medication was administered.
This is because filgrastim is incompatible with dextrose solutions and should not be mixed or diluted with them. Filgrastim should only be administered in normal saline (0.9% sodium chloride) solution. Flushing the IV line with dextrose 5% in water could reduce the effectiveness of filgrastim or cause adverse reactions.
The other data are not reasons to file an incident report, as they are either within the normal range or not related to filgrastim administration.
a. The client had chemotherapy 12 hr before the medication was administered.
This is not a problem, as filgrastim can be given at any time during the chemotherapy cycle, as long as it is not given within 24 hours before or after the chemotherapy dose.
b. The medication vial sat at room temperature for 2 hr before it was administered.
This is acceptable, as filgrastim can be left out at room temperature for up to 24 hours, as long as it is not exposed to direct sunlight or shaken.
c. The client’s absolute neutrophil count was 2,500/mm³ before the medication was administered.
This is within the normal range, as the normal absolute neutrophil count is between 1,500 and 8,000/mm³. Filgrastim can be given to prevent neutropenia or to increase the white blood cell count before apheresis (a procedure to collect stem cells from the blood)
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Related Questions
Correct Answer is C
Explanation
The nurse should instruct the client to administer the medication through clothing if necessary.
In an emergency, an epinephrine auto-injector can be given through clothing.
Choice A is wrong because massaging the site after injection is not mentioned as something to avoid in the instructions for using an epinephrine auto-injector.
Choice B is wrong because the medication should be injected into the outer thigh, not the abdomen.
Choice D is wrong because aspiration prior to administration of the medication is not mentioned as a necessary step in the instructions for using an epinephrine auto-injector.
Correct Answer is C
Explanation
The correct answer is Choice C.
Choice A rationale:
- This response is not appropriate because it is judgmental and may make the client feel defensive.
- It is important for the nurse to respect the client's right to make their own decisions about their health care.
- Telling the client what they should do can undermine their autonomy and potentially damage the nurse-client relationship.
- It's crucial for the nurse to remain objective and avoid imposing their personal opinions or beliefs onto the client.
Choice B rationale:
- This response is also not appropriate because it is using scare tactics to try to persuade the client to get the vaccine.
- This approach can be counterproductive and may further alienate the client.
- It's important to provide accurate information about the risks and benefits of the vaccine in a neutral and non-threatening manner.
Choice C rationale:
- This is the most appropriate response because it acknowledges the client's right to refuse the vaccine while still encouraging them to get it.
- It also demonstrates respect for the client's autonomy and validates their feelings.
- This approach is more likely to foster a positive nurse-client relationship and keep the door open for future discussions about vaccination.
Choice D rationale:
- This response is not accurate because the influenza vaccine is not mandatory for all clients before discharge.
- It is important for the nurse to provide accurate information to the client.
- Threatening the client with an against medical advice form is not appropriate and may be considered a form of coercion.
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