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 client had chemotherapy 12 hr before the medication was administered.
The medication vial sat at room temperature for 2 hr before it was administered.
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 Correct Answer is D
The correct answer is d
Choice A reason:
Administering filgrastim 12 hours after chemotherapy does not typically require an incident report. Filgrastim is often given at least 24 hours after chemotherapy to avoid the risk of increasing the toxicity of the chemotherapy agents. While the timing is closer than recommended, it does not necessarily constitute an error unless specific instructions for the timing were provided by the prescribing physician.
Choice B reason:
The medication vial sitting at room temperature for 2 hours before administration does not require an incident report. Filgrastim can be left out at room temperature for up to 24 hours before use. This is within the safe handling guidelines for the medication.
Choice C reason:
An absolute neutrophil count (ANC) of 2,500/mm³ is within the normal range, which is typically 1,500-8,000/mm³. Filgrastim is used to increase neutrophil counts in patients with low ANC due to chemotherapy. Since the ANC was not low before administration, this would not necessitate an incident report, although it may prompt a review of the necessity of the medication.
Choice D reason:
Flushing the client's IV line with dextrose 5% in water before and after the medication was administered is not the standard procedure and could potentially lead to medication errors or adverse effects. Filgrastim should be diluted in glucose 5% in water for intravenous infusion, but not used to flush the line. This deviation from the standard protocol is what necessitates an incident report.
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Related Questions
Correct Answer is B
Explanation
The client has a negative sputum culture. This indicates that the client is adhering to the medication regimen because a negative sputum culture means that the client is no longer infectious and has cleared the tuberculosis bacteria from their lungs.
Choice A is wrong because testing negative for HIV does not indicate that the client is adhering to the medication regimen for tuberculosis. HIV testing is not related to tuberculosis treatment.
Choice C is wrong because having a positive purified protein derivative test does not indicate that the client is adhering to the medication regimen for tuberculosis.
A positive PPD test means that the client has been exposed to tuberculosis, but it does not indicate whether the client has an active or latent infection. Choice D is wrong because having liver function test results within the expected reference range does not indicate that the client is adhering to the medication regimen for tuberculosis.
Liver function tests are used to monitor for possible adverse effects of isoniazid and rifampin, which can cause hepatotoxicity, but they do not reflect the effectiveness of the treatment.
Correct Answer is A
Explanation
According to various guidelines12345, the recommended rate of intravenous potassium replacement is 10-20 mEq/h with continuous ECG monitoring. The maximum rate is 40 mEq/h in emergency situations. The prescription given by the provider exceeds this limit and could cause cardiac arrhythmias or hyperkalemia.
Choice B is wrong because potassium chloride is a common and appropriate formulation of potassium for intravenous administration.
Choice C is wrong because potassium chloride should not be diluted in dextrose 5% in water, as this could cause hyperglycemia or osmotic diuresis.
Choice D is wrong because potassium should never be given by IV bolus, as this could cause cardiac arrest or tissue necrosis.
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