A client who is taking sildenafil 50 mg PO PRN reports experiencing visual changes to the practical nurse (PN). Which instruction should the PN give to the client?

Choice A reason: Reassuring that neutropenia causes bone pain is incorrect, as the pain is a side effect of filgrastim, not neutropenia. Filgrastim stimulates bone marrow, causing medullary expansion and pain. Misattributing the cause fails to address the drug’s effect, making this choice inappropriate.

Choice B reason: Preparing a variance report is unnecessary, as bone pain is a known filgrastim side effect, not an error. Filgrastim increases neutrophil production, stressing bone marrow and causing pain. Reporting is not the priority; managing the client’s discomfort is more immediate and appropriate.

Choice C reason: Changing the injection site does not alleviate bone pain, as it results from filgrastim’s systemic effect on bone marrow stimulation, not local irritation. Pain is due to increased hematopoiesis in marrow, not the injection itself, making this choice ineffective for addressing the symptom.

Choice D reason: Offering a PRN analgesic addresses bone pain, a common filgrastim side effect caused by bone marrow expansion from stimulated neutrophil production. Analgesics relieve discomfort without altering the drug’s therapeutic effect, making this the most appropriate action to improve client comfort and adherence.

Choice A reason: Peak and trough levels are relevant for drugs like vancomycin, not meloxicam, an NSAID. Meloxicam’s efficacy is assessed clinically via pain reduction, not blood levels, as it inhibits inflammation-causing prostaglandins, making this choice irrelevant for costochondritis management.

Choice B reason: Reassessing pain 30 minutes after meloxicam administration evaluates its effectiveness, as this NSAID reduces cyclooxygenase activity, decreasing prostaglandin-mediated pain and inflammation in costochondritis. Timely reassessment ensures adequate relief, guiding further interventions for breathing discomfort, making this the appropriate intervention.

Choice C reason: Involuntary lip and tongue movements are linked to antipsychotics causing tardive dyskinesia, not meloxicam. This NSAID does not affect neurological pathways causing movement disorders. Monitoring for this is irrelevant, as meloxicam’s primary risks are gastrointestinal, not neurological.

Choice D reason: Strict intake and output monitoring is unnecessary for meloxicam, which targets inflammation, not fluid balance. While long-term use may affect renal function, pain reassessment is more immediate for costochondritis, making this choice less relevant than evaluating therapeutic pain relief.