A nurse is preparing to administer methylprednisolone 60 mg IM to a client. Available is methylprednisolone 80 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest hundredth. Use a leading zero if it applies. Do not use a trailing zero.)

Amphotericin B is a potent polyene antifungalused for systemic mycoses, known for its significant toxicity. It frequently causes an acute infusion-related reactiondue to the release of pro-inflammatory cytokinessuch as TNF-alpha and interleukin-1 during the intravenous administration process.

Rationale:

A.Pedal edema is not typically a sign of an acute infusion reaction; rather, it may indicate renal impairment or fluid volume overload. While amphotericin B is notoriously nephrotoxic, which can eventually lead to fluid retention, this is a chronic complication rather than an immediate reaction. Acute reactions are characterized by systemic inflammatory signs occurring within 1 to 3 hours.

B.A dry cough is not a classic manifestation of an acute infusion reaction to amphotericin B. Respiratory symptoms like dyspnea or tachypnea can occur in severe cases, but they are usually accompanied by more prominent signs of inflammation. A dry cough would more likely be associated with other drug classes, such as ACE inhibitors or pulmonary complications.

C.Fever is a hallmark sign of an acute amphotericin B infusion reaction, often accompanied by chills, rigors, and headache. This occurs as the drug triggers a systemic inflammatory response shortly after the infusion begins. Nurses often pre-medicate clients with antipyretics and antihistamines to mitigate these distressing symptoms, which are sometimes colloquially referred to as "shake and bake."

D.Hyperglycemia is not an expected adverse effect of amphotericin B therapy. The drug primarily impacts renal function and electrolyte balance, specifically causing hypokalemia and hypomagnesemia. Glucose metabolism is not typically altered by polyene antifungals. If hyperglycemia occurs, the nurse should investigate other factors such as the client's intravenous maintenance fluids or underlying diabetic status.

Filgrastim is a granulocyte colony-stimulating factor(G-CSF) used to stimulate the production of neutrophilsand reduce the duration of neutropenia. It acts on hematopoietic cells to increase phagocytic activity, but its timing relative to cytotoxic chemotherapy is critical to prevent drug interaction.

Rationale:

A.A decreased neutrophil count is the primary indication for administering filgrastim, not a reason for an incident report. The medication is specifically intended to treat or prevent febrile neutropenia in clients undergoing myelosuppressive therapy. Finding a low absolute neutrophil count justifies the use of the growth factor to boost the client's immune defense.

B.Filgrastim vials are stable at room temperature for up to 24 hours depending on specific manufacturer guidelines. Leaving the vial out for only 2 hours does not compromise the integrity of the medication or constitute a medication error. Therefore, this action does not necessitate an incident report as the medication remains safe for administration to the client.

C.Filgrastim should not be administered within 24 hours before or after the administration of cytotoxic chemotherapy. Giving the medication only 12 hr after chemotherapy is a significant timing error that can interfere with the effectiveness of the treatment and worsen marrow suppression. The nurse must complete an incident report to document this violation of the safety protocol for colony-stimulating factors.

D.Nausea is a common side effect of chemotherapy and can also occur with filgrastim, though it is not a reason for an incident report. Incident reports are reserved for errors, accidents, or unexpected hazardous events, not for documenting known, documented adverse reactions. The nurse should manage the nausea with antiemetics rather than filing an administrative error report.