A patient with substance use disorder is being started on methadone.
Which of the following is essential for the nurse to monitor? Select all that apply.

Choice A rationale

Ethambutol is an antituberculosis medication. The combination of a sore throat and fever can be indicative of a serious and potentially life-threatening adverse effect of the medication, such as hepatotoxicity or bone marrow suppression, which could manifest as agranulocytosis. Continuing the medication would be highly dangerous and could worsen the patient's condition.

Choice B rationale

Sore throat and fever can signal a severe systemic reaction to ethambutol, potentially indicating drug-induced agranulocytosis or hepatotoxicity. Agranulocytosis, characterized by a critically low white blood cell count (normal range for WBC is 4,500 to 11,000 cells/mm), leaves the body vulnerable to overwhelming infection. Immediate discontinuation of the drug and notifying the healthcare provider is the essential nursing action.

Choice C rationale

Increasing the dose of a medication when a patient is exhibiting signs of a potential adverse drug reaction is contraindicated. The symptoms of sore throat and fever suggest a systemic inflammatory or immune response to the drug. Increasing the dose would likely exacerbate the toxicity and further harm the patient, potentially leading to a more severe outcome.

Choice D rationale

A sore throat and fever in a patient on ethambutol could be a sign of a severe adverse drug reaction, not just a simple bacterial infection. While an infection may be present, the primary concern is the potential for bone marrow suppression. Prescribing an antibiotic without a proper diagnosis would be an inappropriate nursing action, as it is outside the scope of practice and would fail to address the underlying issue.

Choice A rationale

Ensuring the correct medication is given to the right patient is the primary safety priority in medication administration. This fundamental step, part of the "rights" of medication administration, prevents life-threatening errors, such as administering a medication the patient is allergic to or one that is contraindicated for their medical condition.

Choice B rationale

Checking the expiration date is a crucial step to ensure medication efficacy and safety, but it is secondary to patient and medication identification. An expired drug may be ineffective or harmful, but giving the wrong drug to the wrong patient poses an immediate and direct threat to life.

Choice C rationale

Confirming a patient's insurance coverage is an administrative task that has no bearing on the immediate safety or medical necessity of administering the medication. This is a non-clinical function that should not delay or interfere with timely and safe patient care.

Choice D rationale

Documentation of medication administration should always occur after the medication has been given to the patient. Documenting beforehand is an unsafe practice as it can lead to charting errors, such as documenting a medication that was never actually administered, which can endanger the patient.