A nurse is assessing an adult client who is receiving morphine via continuous IV infusion. The nurse should identify that which of the following is the priority finding?

Distended neck veins: Distended neck veins are typically associated with fluid volume excess rather than deficit. In heart failure, venous congestion can cause jugular venous distention, indicating fluid volume overload rather than deficit. Therefore, this finding would not suggest fluid volume deficit in a client with heart failure receiving furosemide.
B) Elevated hematocrit level: Fluid volume deficit, also known as dehydration or hypovolemia, is characterized by a loss of both water and electrolytes from the body, leading to a relative increase in the concentration of red blood cells and other blood components. This increase in concentration results in an elevated hematocrit level, which is a common laboratory finding in clients with fluid volume deficit. Furosemide, a loop diuretic, is commonly used to manage fluid overload in clients with heart failure by promoting diuresis and reducing excess fluid retention. However, excessive diuresis with furosemide can lead to fluid volume deficit if not adequately monitored and managed.

C) Shortness of breath: Shortness of breath is a common symptom of heart failure, particularly when fluid accumulates in the lungs (pulmonary edema) due to fluid volume overload. While shortness of breath may be present in both fluid volume deficit and excess, it is more commonly associated with fluid volume overload in clients with heart failure.

D) Weight gain: Weight gain is indicative of fluid volume excess rather than deficit. In heart failure, weight gain often occurs due to fluid retention, reflecting an increase in total body water and extracellular fluid volume. Monitoring weight is essential in managing heart failure and assessing fluid status, but weight gain would not suggest fluid volume deficit in a client receiving furosemide for heart failure management.

Here’s the calculation to find the filgrastim dosage the nurse should administer per day:

Client weight conversion:

We need the weight in kilograms (kg) for dosage calculation.
Conversion factor: 1 kg = 2.205 pounds
Client weight (kg) = 143 lb / 2.205 lb/kg = 64.86 kg (round to two decimal places for accuracy)
Dosage calculation:

Prescribed dosage: 5 mcg/kg/day
Client weight (kg): 64.86 kg (rounded value from step 1)
Daily filgrastim dose (mcg) = Dosage (mcg/kg/day) x Client weight (kg)
Daily filgrastim dose (mcg) = 5 mcg/kg/day * 64.86 kg = 324.3 mcg (round to nearest whole number as requested)
Therefore, the nurse should administer approximately 324 mcg of filgrastim per day.