A nurse is administering phenytoin to a client. The nurse should monitor for which of the following adverse effects?

A. Hypertension. Filgrastim, a granulocyte colony-stimulating factor (G-CSF), primarily stimulates white blood cell production. While minor blood pressure fluctuations can occur, hypertension is not a common or significant adverse effect. Monitoring blood pressure is important, but sustained hypertension is not expected.

B. Fluid retention. Filgrastim does not typically cause significant fluid retention. Medications such as corticosteroids or certain chemotherapeutic agents are more likely to lead to fluid overload. While rare cases of capillary leak syndrome have been reported, general fluid retention is not a primary concern.

C. Bone pain. Bone pain is the most common adverse effect of filgrastim. The medication stimulates bone marrow activity, leading to increased production of neutrophils, which can cause discomfort in bones, particularly in long bones such as the femur and sternum. Pain is usually mild to moderate and can be managed with acetaminophen or NSAIDs if appropriate.

D. Hypokalemia. Filgrastim does not have a direct effect on potassium levels. Electrolyte imbalances are more commonly associated with diuretics, corticosteroids, or chemotherapy. Clients on filgrastim typically do not require routine potassium monitoring unless other risk factors are present.

A. Anorexia. While gastrointestinal side effects such as nausea and esophageal irritation can occur with alendronate, anorexia is not a common adverse effect. If severe nausea leads to decreased appetite, the client should report this to their provider, but it is not a primary concern compared to more serious side effects.

B. Jaw pain. Jaw pain can indicate osteonecrosis of the jaw (ONJ), a rare but serious adverse effect associated with long-term bisphosphonate use. This condition involves poor bone healing, especially after dental procedures, and can lead to bone deterioration. Clients taking alendronate should report any persistent jaw pain and undergo regular dental exams to monitor bone health.

C. Insomnia. Alendronate does not typically cause insomnia. While some medications, such as corticosteroids and stimulants, are linked to sleep disturbances, alendronate does not affect the central nervous system in a way that would disrupt sleep patterns.

D. Bruising. Alendronate does not interfere with platelet function or coagulation, making bruising an unlikely adverse effect. Clients who experience unexplained bruising should be evaluated for other underlying causes, such as blood disorders or medication interactions.