A nurse is preparing to administer amlodipine to a client. Which of the following vital signs should the nurse assess before administration?

Safe medication administration relies on the elimination of transcription errorsand adherence to established safety guidelines, such as avoiding trailing zeros. The Joint Commission mandates specific labeling standards to prevent dosing inaccuracies that could lead to toxicity or subtherapeutic treatment. Clarifying ambiguous or non-standard prescriptions is a fundamental responsibility of the nurse in maintaining patient safetyand preventing adverse events.

Rationale:

A.The prescription for Clozapine 12.50 mg must be clarified because it contains a trailing zero, which is a prohibited notation according to safety standards. A trailing zero can be misread as 125 mg if the decimal point is missed, leading to a ten-fold dosing error and potential toxicity. Standard practice requires writing the dose as 12.5 mg to ensure clear communication.

B.Lamotrigine 200 mg PO daily is a standard maintenance dose for the treatment of epilepsy or bipolar disorder and does not require clarification. This dosage falls within the typical therapeutic range and the notation is clear and free of dangerous abbreviations or zeros. The nurse should simply continue to monitor the patient for adverse effects like Stevens-Johnson syndrome.

C.Donepezil 23 mg PO daily is an approved dosage for the treatment of moderate-to-severe Alzheimer's disease and is not inherently incorrect. While higher than the starting dose, this specific strength was developed to provide additional cognitive benefits for patients with advanced disease. The notation is clear and follows standard pharmaceutical guidelines, so no clarification is needed based on the dosage.

D.Fluoxetine oral solution 20 mg/5 mL administered via a gastrostomy tube is an appropriate route and dose for a patient who cannot swallow. Liquid formulations are the preferred method for tube administration to prevent clogging and ensure the full dose of the selective serotonin reuptake inhibitor is delivered. This prescription follows clear clinical logic and standard safety practices for enteral medication.

Amphotericin B is a potent polyene antifungalagent utilized for systemic mycotic infections and endocarditis by binding to fungal ergosterolto create membrane pores. Due to its significant nephrotoxicityand risk of infusion-related reactions, specific administration protocols must be strictly followed to ensure patient safety.

Rationale:

A.Administering the medication over 2 hr is the standard protocol to minimize the risk of severe infusion-related reactions and cardiovascular instability. Rapid infusion of amphotericin B can lead to hypotension, bronchospasm, and arrhythmias. By extending the infusion time, the nurse allows for better systemic tolerance and reduces the acute inflammatory response associated with this medication.

B.Using a gravity flow set is incorrect because amphotericin B must be administered via an electronic infusion pump to ensure a precise and consistent rate. Gravity sets are prone to fluctuations that could inadvertently result in a rapid bolus, increasing the risk of cardiac arrest. Precise flow control is a mandatory nursing safety intervention for this high-alert medication.

C.Priming the tubing with 0.9% sodium chloride is contraindicated because amphotericin B is incompatible with saline and will precipitate into solid crystals. The IV line must be primed and flushed exclusively with 5% dextrose in water (D5W) before and after administration. Crystallization in the tubing can lead to emboli or catheter occlusion, posing a significant risk to the patient.

D.Discarding the medication if it is yellow is unnecessary because the amphotericin B lipid complex emulsion is naturally yellow or opaque in appearance. The nurse should only discard the medication if there is evidence of foreign particulate matter or distinct precipitation. Understanding the normal physical characteristics of the drug prevents the wasteful disposal of expensive and essential antifungal therapy.