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?
Reassure the client that neutropenia often causes bone pain
Prepare a variance report about the onset of pain after injection
Plan to administer the next dose at an alternate injection site
Offer to administer a prescribed PRN analgesic to the client
The Correct Answer is D
Choice A reason: Reassuring that neutropenia causes bone pain is incorrect, as the pain is a side effect of filgrastim, not neutropenia. Filgrastim stimulates bone marrow, causing medullary expansion and pain. Misattributing the cause fails to address the drug’s effect, making this choice inappropriate.
Choice B reason: Preparing a variance report is unnecessary, as bone pain is a known filgrastim side effect, not an error. Filgrastim increases neutrophil production, stressing bone marrow and causing pain. Reporting is not the priority; managing the client’s discomfort is more immediate and appropriate.
Choice C reason: Changing the injection site does not alleviate bone pain, as it results from filgrastim’s systemic effect on bone marrow stimulation, not local irritation. Pain is due to increased hematopoiesis in marrow, not the injection itself, making this choice ineffective for addressing the symptom.
Choice D reason: Offering a PRN analgesic addresses bone pain, a common filgrastim side effect caused by bone marrow expansion from stimulated neutrophil production. Analgesics relieve discomfort without altering the drug’s therapeutic effect, making this the most appropriate action to improve client comfort and adherence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Restlessness, tachycardia, fever, and hypertension suggest serotonin syndrome, a life-threatening paroxetine side effect due to excessive serotonin. Withholding the dose and contacting the provider prevents further serotonin accumulation, allowing urgent assessment and intervention to stabilize the client’s neurological and cardiovascular status.
Choice B reason: A cooling blanket addresses fever but is not the first action for serotonin syndrome. Withholding paroxetine and consulting the provider are critical to stop the syndrome’s progression, as fever is a symptom, not the cause, making this choice secondary to halting the drug.
Choice C reason: Taking the client to a quiet area may reduce stimulation but does not address serotonin syndrome’s physiological cause. Paroxetine’s serotonin excess drives symptoms, requiring drug cessation and medical intervention, not just reassurance, as this condition can rapidly worsen, making this choice inadequate.
Choice D reason: Administering benzodiazepine and acetaminophen is premature without provider guidance, as serotonin syndrome requires specific treatments, like cyproheptadine. Paroxetine must be stopped first, and the provider consulted to confirm diagnosis and manage symptoms, making this choice unsafe and reactive.
Correct Answer is B
Explanation
Choice A reason: Stopping disulfiram for nausea or vomiting is incorrect, as these are expected in alcohol reactions, not side effects warranting discontinuation. Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde buildup if alcohol is consumed, leading to these symptoms, which reinforce alcohol avoidance.
Choice B reason: Avoiding all alcohol, including in cough syrups, is critical, as disulfiram causes severe reactions (flushing, nausea) by blocking acetaldehyde metabolism. Even small amounts trigger symptoms, reinforcing abstinence in alcohol dependence treatment, making this the most important instruction for safety and efficacy.
Choice C reason: Taking disulfiram at the same time daily promotes adherence but is less critical than avoiding alcohol, which directly prevents severe reactions. Consistency aids therapeutic levels, but alcohol exposure poses immediate health risks, making this instruction secondary.
Choice D reason: Weekly blood tests are not standard for disulfiram, as therapeutic levels are not routinely monitored, and sodium is unaffected. Liver function may be checked periodically, but alcohol avoidance is the priority to prevent acute reactions, making this choice incorrect.
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