A nurse is caring for a client who is taking azathioprine to treat rheumatoid arthritis. Which of the following laboratory values indicates an adverse effect of this medication?

Choice A Reason:
Identify the client using two identifiers is correct. Prior to administering any medication, especially controlled substances, it's crucial to confirm the client's identity using two unique identifiers, such as their name and date of birth or an identification band and verbal confirmation. Ensuring accurate identification helps prevent medication errors and ensures the right medication is given to the right patient.
Choice B Reason:
Compare the amount of medication available to the inventory record is incorrect. This is part of maintaining accurate documentation and inventory control, ensuring that the amount of medication matches the recorded inventory. However, it typically occurs after confirming the client's identity.
Choice C Reason:
Document the administration of the medication is incorrect. Documentation of medication administration is crucial for legal and medical purposes but should occur after the medication has been safely administered to the correct patient.
Choice D Reason:
Remove the medication from the medication dispensing cabinet is incorrect. Retrieving the medication from the dispensing cabinet is an essential step in the administration process, but it should occur after confirming the client's identity to ensure the right medication is administered to the right individual.

Choice A Reason:
. "I will check the client's INR before administering the heparin." Is incorrect. Checking the client's INR (International Normalized Ratio) is essential, but it's more applicable for monitoring anticoagulants like warfarin, not heparin. Heparin's effect is typically monitored via activated partial thromboplastin time (aPTT) or anti-Xa levels, not INR.
Choice B Reason:
"I will aspirate before administering the heparin." Is incorrect. Aspirating before administering heparin injections is not necessary because the medication is given subcutaneously or intravenously and not into a blood vessel.
Choice C Reason:
"I will massage the site after injecting the heparin." Is incorrect. Massaging the site after injecting heparin could increase the risk of bruising or hematoma formation at the injection site. It's generally advised to avoid massaging the area after a heparin injection to prevent tissue trauma.
Choice D Reason:
"I will apply pressure for 1 minute after the injection." Is correct. Applying pressure to the injection site for about a minute after administering heparin helps minimize the risk of bleeding or hematoma formation, especially with subcutaneous injections. This practice aids in reducing bleeding at the injection site.