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

Levodopa is a dopamine precursorthat crosses the blood-brain barrier to treat Parkinson's disease by replenishing depleted striatal dopamine. When combined with non-selective monoamine oxidase inhibitors(MAOIs), it can trigger a massive release of catecholamines, leading to a dangerous hypertensive crisis. This sympathomimetic surgeresults from the simultaneous increase in dopamine synthesis and the inhibition of its metabolic breakdown.

Rationale:

A.Phenelzine is a non-selective MAOI that, when taken with levodopa, can lead to a life-threatening hypertensive crisis. This occurs because levodopa increases dopamine levels while phenelzine prevents the enzymatic breakdown of monoamines, resulting in excessive systemic vasoconstriction. The nurse must ensure a washout period of at least 14 days between these two specific pharmacological agents.

B.Ibuprofen is a non-steroidal anti-inflammatory drug that does not typically have a life-threatening interaction with levodopa. While all medications should be monitored for general side effects, ibuprofen does not interfere with the dopaminergic pathways or metabolic breakdown of levodopa. It is generally considered safe for managing mild musculoskeletal pain in patients with Parkinson's disease.

C.Diphenhydramine is an antihistamine with anticholinergic properties that is sometimes used as an adjunct in Parkinson's therapy to reduce tremors. It does not cause a life-threatening complication when paired with levodopa; in fact, it may provide synergistic benefits for motor symptoms. However, the nurse should monitor the patient for increased sedation and urinary retention.

D.Vitamin B12 is a water-soluble vitamin essential for neurological health and does not interact dangerously with levodopa. It is often pyridoxine (Vitamin B6) that is of concern, as B6 can increase the peripheral conversion of levodopa, reducing its efficacy. Vitamin B12 supplementation is generally safe and does not pose a risk for hypertensive or catecholamine-related emergencies.

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.