A nurse is caring for a client who has cirrhosis of the liver and is receiving spironolactone. Which of the following findings indicates that the client responding to the treatment?

Answer: B. Keep the solution refrigerated until 1 hr before infusion.

Rationale:

A) Obtain the client's weight three times a week: While monitoring weight is essential to assess fluid balance and nutritional status in clients receiving TPN, daily weight measurements are more appropriate to detect rapid changes.

B) Keep the solution refrigerated until 1 hr before infusion: TPN solutions should be refrigerated to prevent bacterial growth and maintain stability. Removing the solution from refrigeration 1 hour before infusion allows it to warm to room temperature, reducing the risk of discomfort during administration.

C) Change the solution every 36 hr: TPN solutions should be changed every 24 hours to minimize the risk of bacterial contamination and infection, especially since the high glucose content is a favorable medium for bacterial growth.

D) Check the client's WBC count daily: While monitoring for infection is vital, checking the WBC count daily is not a routine requirement unless the client shows signs of infection or complications. Regular temperature checks and observing for clinical signs of infection are usually sufficient.

A) Return the remaining medication to the facility's pharmacy: Returning the remaining medication to the pharmacy is not appropriate in this situation because the medication has been removed from its original packaging and administered to the patient. Once medication has been removed from its original packaging and administered, it cannot be returned to the pharmacy for reuse or storage due to contamination risks and potential medication errors.

B) Dispose of the remaining medication while another nurse observes: This is the correct action. Since the prescribed dose is only half of the tablet, the nurse should dispose of the remaining half of the tablet while another nurse observes, ensuring proper disposal and adherence to medication administration policies and procedures. This prevents errors in subsequent doses and ensures accurate medication administration.

C) Store the remaining half of the pill in the automated medication dispensing system: Storing the remaining half of the pill in the automated medication dispensing system is not appropriate because the medication has already been removed from its original packaging and administered to the patient. Storing half tablets in the automated dispensing system could lead to medication errors and confusion during future administrations.

D) Place the remaining half of the pill in the unit-dose package: Placing the remaining half of the pill in the unit-dose package is not appropriate because the medication has already been removed from its original packaging and administered to the patient. Placing half tablets back into the unit-dose package could lead to medication errors and confusion during future administrations.