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: Taking medications with food may reduce gastric irritation but does not prevent anaphylactic reactions to penicillin, which are immune-mediated. This advice is irrelevant for avoiding future allergic responses, as it does not address the systemic hypersensitivity triggered by penicillin exposure.

Choice B reason: A medic alert bracelet is critical for a client with a penicillin anaphylaxis history, as it alerts healthcare providers to avoid penicillin, preventing potentially fatal allergic reactions. Anaphylaxis involves IgE-mediated histamine release, and re-exposure risks rapid, life-threatening symptoms, making this the most important instruction.

Choice C reason: Keeping epinephrine is useful for managing anaphylaxis but is secondary to prevention. A medic alert bracelet proactively avoids penicillin exposure, reducing the need for emergency intervention. Epinephrine treats symptoms but does not address the root cause of re-exposure risk.

Choice D reason: Taking all prescribed ampicillin is dangerous, as the client had an anaphylactic reaction, indicating a severe allergy. Continuing the drug risks recurrent, potentially fatal reactions. This choice is incorrect, as it contradicts the need to avoid the allergen entirely.

Choice A reason: Instructing the UAP to bring a breakfast tray ensures nutritional support but is not the highest priority. Regular insulin peaks within 2–4 hours, risking hypoglycemia if not monitored. Observing for hypoglycemic symptoms takes precedence to ensure immediate safety post-administration.

Choice B reason: Observing for pallor, diaphoresis, or fatigue is critical, as these indicate hypoglycemia, a serious risk after regular insulin administration. Insulin lowers blood glucose, and rapid drops can impair brain function or cause seizures. Monitoring for these signs ensures timely intervention, prioritizing client safety.

Choice C reason: Measuring vital signs and oxygen saturation provides general data but is less specific than monitoring for hypoglycemia symptoms. Regular insulin’s rapid action increases hypoglycemic risk, and symptoms like diaphoresis are more direct indicators, making this choice secondary to targeted observation.

Choice D reason: Notifying the charge nurse of the insulin dose is routine but not urgent. The priority is monitoring for hypoglycemia, as regular insulin can cause rapid glucose drops, leading to serious complications. Immediate client observation outweighs administrative tasks in ensuring safety.