A nurse recently administered filgrastim intravenously to a client who has cancer and is receiving cytotoxic chemotherapy. For which of the following data, discovered after the medication was administered, should the nurse file an incident report?
The medication vial sat at room temperature for 2 hr before it was
The client's absolute neutrophil count was 2,500/mm3 before the medication was administered.
The nurse flushed the client's IV line with dextrose 5% in water before and after the medication was administered.
The client had chemotherapy 12 hr before the medication was administered.
The Correct Answer is A
Choice A Reason:
The medication vial sat at room temperature for 2 hr before it was administered is correct. Medications like filgrastim typically have specific storage requirements, including temperature control. Allowing the medication vial to sit at room temperature for an extended period may compromise its stability or effectiveness, leading to potential concerns regarding medication safety. Reporting incidents related to improper medication storage is essential to ensure patient safety and prevent similar occurrences in the future.
Choice B Reason:
The client's absolute neutrophil count was 2,500/mm3 before the medication was administered. Is incorrect. A normal or adequate absolute neutrophil count (ANC) of 2,500/mm3 before administering filgrastim is not an adverse event that requires an incident report.
Choice C Reason:
The nurse flushed the client's IV line with dextrose 5% in water before and after the medication was administered. Is incorrect. Flushing the IV line with dextrose 5% in water is a standard practice and not considered an adverse event or reason for filing an incident report.
Choice D Reason:
The client had chemotherapy 12 hr before the medication was administered. Is incorrect. The timing of previous chemotherapy administration, in this case, doesn't inherently suggest an adverse event requiring an incident report.
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Correct Answer is B
Explanation
Choice A Reason:
Remove duplicate medications of different dosages from the reconciliation is incorrect. Removing duplicate medications with different dosages from the reconciliation is indeed essential. However, the primary focus during transfer is to compare the current medication list with the new regimen to avoid omissions or discrepancies in the transition process.
Choice B Reason:
Compare the current list of medications to medications the client will receive after transform is correct. Comparing the current list of medications, the client is taking to the medications they are expected to receive after transfer is crucial for ensuring a seamless transition of care. This process helps identify discrepancies, potential interactions, or changes in the medication regimen between settings, ensuring the continuity and accuracy of medication administration.
Choice C Reason:
Omit over-the-counter medications from the at-home medication list is incorrect. Over-the-counter medications should ideally be included in the medication reconciliation process to provide a comprehensive overview of all medications the client is taking, including potential interactions with prescribed medications.
Choice D Reason:
Include medications the client received in the acute setting but will no longer need after transfer is incorrect. The reconciliation process should aim to update the medication list to reflect the client's current and future medication needs accurately. Including medications, the client received in the acute setting but won't need after transfer might introduce unnecessary medications into the new regimen. These should be communicated but not included in the ongoing medication list.
Correct Answer is C
Explanation
Choice A Reason:
Levothyroxine 100 mcg PO every morning is incorrect. Indicates the dosage (100 mcg) and the route (by mouth) to be taken every morning.
Choice B Reason:
Simvastatin 40 mg PO at bedtime: Specifies the dosage (40 mg) and the timing (at bedtime) for administration.
Choice C Reason:
Acetaminophen 500 mg every 4 hr RN for fever is correct. The term "RN" in this context might be interpreted as "right now" rather than the intended meaning, which could cause confusion regarding the frequency of acetaminophen administration. The nurse should seek clarification to ensure accurate and safe dosing instructions.
Choice D Reason:
Morphine 4 mg IV every 4 hr PRN for pain: Specifies the dosage (4 mg), the route (intravenous), and the frequency (every 4 hours as needed) for pain management.
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