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?

A. Rotate the application site every week (Correct Answer): This is the correct advice. Rotating the application site helps prevent skin irritation and enhances absorption. It's common practice to apply the patch to a different, clean, and hairless area of the skin each time it is changed.
B. The transdermal patch releases nicotine rapidly into the bloodstream: This statement is incorrect. The transdermal nicotine patch is designed to release nicotine gradually over an extended period. It provides a steady, controlled release of nicotine to help manage withdrawal symptoms and cravings.
C. Leave the patch in place for 8 hr each day: The specific duration for wearing a nicotine patch can vary depending on the product. However, it's generally recommended to wear the patch for 16 to 24 hours, depending on the product's instructions. Leaving it on for 8 hours only may not provide adequate coverage for the entire day.
D. The transdermal patch can cause insomnia: While insomnia is a potential side effect of nicotine replacement therapy, including the patch, it is not a universal experience for everyone. Insomnia is more likely to occur if the patch is worn continuously, including during the night. Following proper usage guidelines, such as removing the patch before bedtime, can help minimize this side effect.

A. INR (International Normalized Ratio): INR is a measure of blood clotting and is not directly affected by filgrastim, which stimulates the production of white blood cells. Monitoring INR is more relevant when assessing anticoagulant therapy.
B. Potassium level: Filgrastim does not directly influence potassium levels. Monitoring potassium is important for certain medications and conditions, but it is not the primary parameter to evaluate the effectiveness of filgrastim.
C. WBC count: Filgrastim (granulocyte colony-stimulating factor) is used to stimulate the production of white blood cells, specifically neutrophils. Monitoring the white blood cell count is crucial in evaluating the effectiveness of filgrastim treatment. An increase in the WBC count, particularly the neutrophil count, indicates a positive response to the medication.
D. BUN (Blood Urea Nitrogen): BUN is a measure of kidney function and is not directly influenced by filgrastim. While monitoring kidney function is important in general patient care, it is not the primary parameter to assess the effectiveness of filgrastim.