Patient Data

Exhibits

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The nurse should expect for the insulin lispro to start working at

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and to peak at

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.

Choice A rationale: Nausea is the symptom the medication is intended to treat, and it is expected that the client may have some level of nausea while undergoing chemotherapy. It is not the most important adverse effect to report in this scenario.

Choice B rationale: Diarrhea is not a common or significant adverse effect of metoclopramide. While it is essential to monitor for any gastrointestinal side effects, it is not the most important adverse effect to report in this case.

Choice C rationale: Metoclopramide is a medication commonly used to treat nausea and vomiting, particularly related to chemotherapy. One of the significant adverse effects of metoclopramide is the potential to cause extrapyramidal symptoms, including involuntary movements such as dystonia, dyskinesia, and Parkinsonism. These extrapyramidal symptoms can be serious and may require immediate intervention or discontinuation of the medication.

Therefore, it is essential for the nurse to closely monitor the client for any signs of involuntary movements and report them promptly to the healthcare provider for appropriate management.

Choice D rationale: Unusual irritability is not a typical adverse effect associated with metoclopramide. While mood changes can occur with any medication, involuntary movements are a more concerning side effect that requires immediate attention and reporting.

A. Two hours after completion is too late to accurately capture the peak serum concentration, and drawing a trough two hours before the next dose will result in an artificially elevated trough level, as the drug has not yet cleared to its lowest concentration.

B. One hour after completion may miss the true peak concentration for intravenous vancomycin, and drawing a trough one hour before the next dose does not represent the absolute lowest point of the medication's therapeutic window.

C. Thirty minutes into the infusion is too early to measure a peak because the entire dose has not yet been delivered into the bloodstream, which can lead to inaccurate clinical decision-making.

D. To capture the maximum concentration of the drug in the bloodstream, the peak level should be drawn immediately after completion of the intravenous infusion (or within 30 to 60 minutes depending on facility protocol and infusion duration). To capture the lowest concentration, the trough level must be drawn immediately prior to the next scheduled dose, typically 30 minutes before administration.