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's absolute neutrophil count was 2.500/mm before the medication was administered
The nurse flushed the client's (V line with dextrose 5% in water before and after the medication was administered
The medication vial sat at room temperature for 2 hr before it was administered
The client had chemotherapy 12 hr before the medication was administered
The Correct Answer is C
A. The client's absolute neutrophil count was 2.500/mm before the medication was administered:
This information does not indicate an error in the administration process. The absolute neutrophil count being 2.500/mm before the medication was given is relevant to the client's condition but does not suggest an incident related to the administration of filgrastim.
B. The nurse flushed the client's IV line with dextrose 5% in water before and after the medication was administered:
Flushing the IV line with dextrose 5% in water is a standard practice before and after medication administration. This action helps ensure that the medication is effectively delivered and that the line remains patent. There is no indication of an error in this case.
C. The medication vial sat at room temperature for 2 hr before it was administered:
Filgrastim is a medication that typically requires refrigeration to maintain stability. Allowing it to sit at room temperature for an extended period can affect its efficacy and safety. This is a deviation from the recommended storage conditions and should be reported as an incident to assess potential consequences.
D. The client had chemotherapy 12 hr before the medication was administered:
This information does not necessarily suggest an incident related to the administration of filgrastim. The timing of chemotherapy is an essential consideration in cancer treatment protocols. Filgrastim is often administered to support recovery from the hematopoietic effects of chemotherapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Decrease in urine output:
This is the correct answer. Desmopressin is a synthetic form of antidiuretic hormone (ADH) that works to reduce urine output in individuals with diabetes insipidus. A decrease in urine output indicates a positive response to the medication.
B. Increase in serum glucose:
Desmopressin does not have a direct effect on serum glucose levels. Its primary action is to increase water reabsorption in the kidneys, reducing urine output.
C. Increase in WBC count:
Desmopressin does not have a direct impact on white blood cell (WBC) count. Its main action is on fluid balance and urine concentration.
D. Decrease in blood pressure:
Desmopressin can cause a mild increase in blood pressure, particularly at higher doses. However, blood pressure changes are not the primary therapeutic effect of desmopressin in the context of diabetes insipidus.
Correct Answer is C
Explanation
A. A vein that feels hard to the touch:
A vein that feels hard to the touch may indicate thrombosis or inflammation and is not a suitable site for catheter insertion.
B. A vein in the client's dominant arm:
The choice of arm may depend on the client's preference, but it is not a strict rule. The nurse can choose a suitable vein in either arm based on factors such as accessibility and vein condition.
C. A vein proximal to the previous site:
This is the correct answer. Placing the catheter proximal (above or upstream) to the previous site helps minimize the risk of complications such as infiltration and thrombophlebitis at the new site. It allows for optimal vein health and reduces the likelihood of complications associated with repeated punctures in the same area.
D. A vein on the client's wrist:
Veins on the wrist may be smaller and more prone to complications. It is generally recommended to choose larger, more accessible veins for catheter insertion.
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