The practical nurse (PN) administers filgrastim subcutaneous to a client with neutropenia. The client becomes troubled with bone pain. Which action should the PN take?

Choice A reason: Iodine allergy is irrelevant to golimumab, a tumor necrosis factor (TNF) inhibitor, as it is not iodine-based. Allergic reactions to biologics are possible but unrelated to iodine sensitivity, making this choice unnecessary for ensuring safe administration of the medication.

Choice B reason: Flu vaccination status is relevant for general health but not critical before golimumab administration. While immunosuppression increases infection risk, tuberculosis screening is more urgent, as TNF inhibitors can reactivate latent TB, posing a severe health threat.

Choice C reason: A recent tuberculosis test is essential, as golimumab suppresses TNF, increasing the risk of reactivating latent TB into active disease. Screening with a tuberculin test or interferon-gamma assay prevents potentially fatal infections, making this the most critical information before starting therapy.

Choice D reason: Oral contraceptive use is unrelated to golimumab’s safety or efficacy. While some drugs interact with contraceptives, golimumab does not, and psoriasis treatment does not involve reproductive considerations, making this choice irrelevant for pre-administration assessment.

Choice A reason: Suggesting a snack after administering an incorrect insulin dose risks hypoglycemia, as 2 extra units can excessively lower blood glucose. Insulin dosing must match the glucose level per the sliding scale to prevent adverse effects, making this choice unsafe and reactive.

Choice B reason: Repeating the glucose level is unnecessary if the recorded level is reliable. The error lies in the drawn dose, not the glucose measurement. Correcting the dose to match the recorded glucose is more direct, as insulin dosing relies on accurate glucose data.

Choice C reason: Reducing the insulin dose by 2 units corrects the error, aligning with the sliding scale for the recorded glucose level. Excess insulin can cause hypoglycemia, affecting brain and organ function. This action ensures safe administration, preventing potentially severe metabolic consequences.

Choice D reason: Recording the discrepancy does not correct the dosing error and risks administering an unsafe dose. Documentation is secondary to ensuring the correct insulin amount is given, as 2 extra units could lead to hypoglycemia, requiring immediate correction, not just notation.