A hospice nurse is caring for a client who has a fentanyl patch applied. The client appears restless and agitated. Which of the following actions should the nurse take?

A. INR (International Normalized Ratio): INR is primarily used to monitor the effectiveness of anticoagulant therapy, such as warfarin. It is not directly related to the effectiveness of filgrastim, which is a medication used to stimulate the production of white blood cells (WBCs).

B. WBC count: Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that stimulates the bone marrow to produce more white blood cells, particularly neutrophils. Monitoring the WBC count helps assess the effectiveness of filgrastim in increasing the client's white blood cell levels, which is essential for fighting infections.

C. BUN (Blood Urea Nitrogen): BUN is a measure of kidney function and hydration status. While it is an important laboratory value to monitor in many clinical situations, it is not directly related to the effectiveness of filgrastim.

D. Potassium level: Potassium levels are essential for normal cellular function, but they are not specific markers for assessing the effectiveness of filgrastim therapy. Monitoring potassium levels is important for identifying electrolyte imbalances but does not directly evaluate the therapeutic response to filgrastim.

A. “Document the updated list and send it to the pharmacy”: While this is an important step in the medication reconciliation process, it is not the first step. The nurse must first have a complete and accurate list of all the medications the client is currently taking.

B. “Compile a list of all medications the client is currently taking”: This is the first step in the medication reconciliation process. The nurse needs to know all the medications the client is currently taking, including prescription drugs, over-the-counter medications, herbal supplements, and any other substances. This list should include the name of each medication, the dose, the frequency, and the route of administration.

C. “Compare preadmission medications to current medications”: This is an important step in the medication reconciliation process, but it cannot be done until after the nurse has compiled a list of all medications the client is currently taking.

D. “Address any discrepancies between current medications and new prescriptions”: Addressing discrepancies is a crucial part of the medication reconciliation process, but it is not the first step. The nurse must first compile a list of all medications the client is currently taking, then compare this list to the client’s preadmission medications and any new prescriptions.