A nurse is caring for a client who is in shock and is receiving an infusion of albumin.
Which of the following findings should the nurse expect?

The correct answer is d

Choice A reason:

Administering filgrastim 12 hours after chemotherapy does not typically require an incident report. Filgrastim is often given at least 24 hours after chemotherapy to avoid the risk of increasing the toxicity of the chemotherapy agents. While the timing is closer than recommended, it does not necessarily constitute an error unless specific instructions for the timing were provided by the prescribing physician.

Choice B reason:

The medication vial sitting at room temperature for 2 hours before administration does not require an incident report. Filgrastim can be left out at room temperature for up to 24 hours before use. This is within the safe handling guidelines for the medication.

Choice C reason:

An absolute neutrophil count (ANC) of 2,500/mm³ is within the normal range, which is typically 1,500-8,000/mm³. Filgrastim is used to increase neutrophil counts in patients with low ANC due to chemotherapy. Since the ANC was not low before administration, this would not necessitate an incident report, although it may prompt a review of the necessity of the medication.

Choice D reason:

Flushing the client's IV line with dextrose 5% in water before and after the medication was administered is not the standard procedure and could potentially lead to medication errors or adverse effects. Filgrastim should be diluted in glucose 5% in water for intravenous infusion, but not used to flush the line. This deviation from the standard protocol is what necessitates an incident report.

The nurse should instruct the client to avoid drinking beverages while sucking on a nicotine lozenge because this can interfere with the absorption of nicotine and reduce its effectiveness. Some possible explanations for the other choices are:

Choice B is wrong because chewing nicotine gum for 10 minutes before spitting it out is too short.

The recommended duration is at least 30 minutes to allow enough nicotine to be released and absorbed through the lining of the mouth.

Choice C is wrong because changing the nicotine patch every other day is not frequent enough.

The patch should be changed daily and applied to a different skin site to prevent irritation and ensure a steady dose of nicotine.

Choice D is wrong because administering 2 sprays of nicotine nasal spray in each nostril with each dose is too much.

The recommended dose is one spray per nostril, up to five times per hour or 40 times per day.

Using too much nasal spray can cause side effects such as nasal irritation, sneezing, coughing, headache, or nausea.