The nurse is caring for a patient receiving chemotherapy who is admitted with an absolute neutrophil count (ANC) of 459 cells/ulu. The healthcare provider orders G-CSF (filgrastim). Which action will the nurse take to promote safe and effective use of filgrastim for this patient?

Monitor the patient's ANC daily and stop medication when the ANC is greater than 20,000 cells/ulu.

Teach the patient how to administer the medication via intramuscular.

Ensure the patient understands the risk of bone pain and how to manage it.

Administer filgrastim as needed for symptoms of infection.

Answer and Explanation

The Correct Answer is C

Choice A reason: Monitoring the patient's absolute neutrophil count (ANC) daily and stopping medication when the ANC is greater than 20,000 cells/uL is an essential aspect of using filgrastim safely. However, this is typically managed by the healthcare provider and not the primary action for the nurse to take for patient education. The nurse's role focuses more on educating the patient about potential side effects and self-care.

Choice B reason: Teaching the patient how to administer the medication via intramuscular is not relevant for filgrastim, as it is typically administered via subcutaneous injection. Proper administration technique is crucial for ensuring the medication's effectiveness, but this choice does not accurately reflect the standard administration method for filgrastim.

Choice C reason: Ensuring the patient understands the risk of bone pain and how to manage it is crucial for promoting safe and effective use of filgrastim. Bone pain is a common side effect of filgrastim due to the stimulation of bone marrow to produce more neutrophils. Educating the patient about this potential side effect and providing strategies for managing the pain, such as using over-the-counter pain relievers, helps improve patient comfort and adherence to the medication.

Choice D reason: Administering filgrastim as needed for symptoms of infection is not appropriate. Filgrastim is used to stimulate neutrophil production and prevent infection, rather than treating active infections. The medication should be administered according to the prescribed schedule, not based on the presence of infection symptoms.

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Correct Answer is B

Explanation

Choice A reason: Kussmaul breathing is a sign of metabolic acidosis, not metabolic alkalosis. It is characterized by deep, labored breathing as the body tries to expel excess carbon dioxide.

Choice B reason: Positive Chvostek sign is an indication of hypocalcemia, which can be associated with metabolic alkalosis. It is a facial muscle twitch that occurs when the facial nerve is tapped.

Choice C reason: Hematemesis, or vomiting blood, is not a clinical manifestation of metabolic alkalosis. It is more related to gastrointestinal bleeding.

Choice D reason: Distended jugular veins are more commonly associated with conditions such as heart failure and fluid overload, not specifically with metabolic alkalosis.

A. The patient newly diagnosed with heart failure whose pulse oximetry is 94% on 2L oxygen. B. A patient scheduled for echocardiogram who has altered level of consciousness and restlessness. C. The patient who has dyspnea on exertion but wants to be discharged against medical advice. D. The patient whose ejection fraction (EF) is 50% and has 2+ bilateral lower extremity edema.

Correct Answer is B

Explanation

Choice A reason: The patient with heart failure whose pulse oximetry is 94% on 2L oxygen is stable at the moment. While they require monitoring, they do not take immediate priority over the patient with altered consciousness.

Choice B reason: Altered level of consciousness and restlessness are critical symptoms that require immediate assessment. These could indicate a life-threatening condition such as hypoxia, electrolyte imbalance, or stroke, necessitating prompt evaluation and intervention.

Choice C reason: The patient with dyspnea on exertion who wants to be discharged against medical advice is important, but altered consciousness takes precedence due to its potential severity.

Choice D reason: The patient with an ejection fraction of 50% and 2+ bilateral lower extremity edema is stable and does not require immediate intervention compared to the patient with altered consciousness.

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The nurse is caring for a patient receiving chemotherapy who is admitted with an absolute neutrophil count (ANC) of 459 cells/ulu. The healthcare provider orders G-CSF (filgrastim). Which action will the nurse take to promote safe and effective use of filgrastim for this patient?

Nursing Test Bank

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