Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse recently administered filgrastim intravenously to a client who has cancer and is receiving cytotoxic chemotherapy.
For which of the following data, discovered after the medication was administered, should the nurse file an incident report?
A. The client had chemotherapy 12 hr before the medication was administered.
Administering filgrastim 12 hours after chemotherapy does not typically require an incident report. Filgrastim is often given at least 24 hours after chemotherapy to avoid the risk of increasing the toxicity of the chemotherapy agents. While the timing is closer than recommended, it does not necessarily constitute an error unless specific instructions for the timing were provided by the prescribing physician.
B. The medication vial sat at room temperature for 2 hr before it was administered.
The medication vial sitting at room temperature for 2 hours before administration does not require an incident report. Filgrastim can be left out at room temperature for up to 24 hours before use. This is within the safe handling guidelines for the medication.
C. The client’s absolute neutrophil count was 2,500/mm3 before the medication was administered.
An absolute neutrophil count (ANC) of 2,500/mm³ is within the normal range, which is typically 1,500-8,000/mm³. Filgrastim is used to increase neutrophil counts in patients with low ANC due to chemotherapy. Since the ANC was not low before administration, this would not necessitate an incident report, although it may prompt a review of the necessity of the medication.
D. The nurse flushed the client’s IV line with dextrose 5% in water before and after the medication was administered.
Flushing the client's IV line with dextrose 5% in water before and after the medication was administered is not the standard procedure and could potentially lead to medication errors or adverse effects. Filgrastim should be diluted in glucose 5% in water for intravenous infusion, but not used to flush the line. This deviation from the standard protocol is what necessitates an incident report.
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN Pharmacology 2019 Proctored Exam. Take the full exam now
Full Explanation
The correct answer is d
Choice A reason:
Administering filgrastim 12 hours after chemotherapy does not typically require an incident report. Filgrastim is often given at least 24 hours after chemotherapy to avoid the risk of increasing the toxicity of the chemotherapy agents. While the timing is closer than recommended, it does not necessarily constitute an error unless specific instructions for the timing were provided by the prescribing physician.
Choice B reason:
The medication vial sitting at room temperature for 2 hours before administration does not require an incident report. Filgrastim can be left out at room temperature for up to 24 hours before use. This is within the safe handling guidelines for the medication.
Choice C reason:
An absolute neutrophil count (ANC) of 2,500/mm³ is within the normal range, which is typically 1,500-8,000/mm³. Filgrastim is used to increase neutrophil counts in patients with low ANC due to chemotherapy. Since the ANC was not low before administration, this would not necessitate an incident report, although it may prompt a review of the necessity of the medication.
Choice D reason:
Flushing the client's IV line with dextrose 5% in water before and after the medication was administered is not the standard procedure and could potentially lead to medication errors or adverse effects. Filgrastim should be diluted in glucose 5% in water for intravenous infusion, but not used to flush the line. This deviation from the standard protocol is what necessitates an incident report.
Similar Questions
A nurse is caring for a client who is to receive potassium replacement. The provider’s prescription reads, “Potassium chloride 30 mEq in 0.9% sodium chloride 100 mL IV over 30 min.” For which of the following reasons should the nurse clarify this prescription with the provider?
A. The potassium infusion rate is too rapid.
According to various guidelines12345, the recommended rate of intravenous potassium replacement is 10-20 mEq/h with continuous ECG monitoring. The maximum rate is 40 mEq/h in emergency situations. The prescription given by the provider exceeds this limit and could cause cardiac arrhythmias or hyperkalemia.
B. Another formulation of potassium should be given IV.
Choice B is wrong because potassium chloride is a common and appropriate formulation of potassium for intravenous administration.
C. Potassium chloride should be diluted in dextrose 5% in water.
Choice C is wrong because potassium chloride should not be diluted in dextrose 5% in water, as this could cause hyperglycemia or osmotic diuresis.
D. The client should be treated by giving potassium by IV bolus.
Choice D is wrong because potassium should never be given by IV bolus, as this could cause cardiac arrest or tissue necrosis.
Full Explanation
According to various guidelines12345, the recommended rate of intravenous potassium replacement is 10-20 mEq/h with continuous ECG monitoring. The maximum rate is 40 mEq/h in emergency situations. The prescription given by the provider exceeds this limit and could cause cardiac arrhythmias or hyperkalemia.
Choice B is wrong because potassium chloride is a common and appropriate formulation of potassium for intravenous administration.
Choice C is wrong because potassium chloride should not be diluted in dextrose 5% in water, as this could cause hyperglycemia or osmotic diuresis.
Choice D is wrong because potassium should never be given by IV bolus, as this could cause cardiac arrest or tissue necrosis.
A nurse is reviewing the medical record of an adult client who has a fever and a prescription for acetaminophen.
Which of the following findings should the nurse identify as a contraindication for receiving this medication?
A. Hepatitis B vaccine within the last week.
Choice A is wrong because hepatitis B vaccine within the last week is not a contraindication for receiving acetaminophen. There is no evidence that acetaminophen interferes with the immune response to the vaccine or causes adverse effects.
B. Chronic kidney disease.
Choice B is wrong because chronic kidney disease is not a contraindication for receiving acetaminophen. Acetaminophen is mainly metabolized by the liver and has minimal renal excretion. However, patients with chronic kidney disease should consult their doctor before taking acetaminophen as they may have other conditions that affect its use.
C. Diabetes mellitus.
Choice C is wrong because diabetes mellitus is not a contraindication for receiving acetaminophen. Acetaminophen does not affect blood glucose levels or interact with oral antidiabetic drugs. However, patients with diabetes mellitus should consult their doctor before taking acetaminophen as they may have other conditions that affect its use.
D. Alcohol use disorder.
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease1 and should be used with caution in patients with hepatic impairment or active liver disease. Alcohol use disorder can cause liver damage and increase the risk of acetaminophen toxicity.
Full Explanation
Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease1 and should be used with caution in patients with hepatic impairment or active liver disease. Alcohol use disorder can cause liver damage and increase the risk of acetaminophen toxicity.
Choice A is wrong because hepatitis B vaccine within the last week is not a contraindication for receiving acetaminophen.
There is no evidence that acetaminophen interferes with the immune response to the vaccine or causes adverse effects.
Choice B is wrong because chronic kidney disease is not a contraindication for receiving acetaminophen.
Acetaminophen is mainly metabolized by the liver and has minimal renal excretion.
However, patients with chronic kidney disease should consult their doctor before taking acetaminophen as they may have other conditions that affect its use.
Choice C is wrong because diabetes mellitus is not a contraindication for receiving acetaminophen.
Acetaminophen does not affect blood glucose levels or interact with oral antidiabetic drugs.
However, patients with diabetes mellitus should consult their doctor before taking acetaminophen as they may have other conditions that affect its use.
A nurse is planning care for a client who requires treatment for high cholesterol. Which of the following prescriptions should the nurse expect to administer?
A. Chlorpromazine.
Chlorpromazine is wrong because it is an antipsychotic medication that has no effect on cholesterol levels.
B. Colesevelam.
Colesevelam is a bile acid sequestrant that lowers cholesterol by binding to bile acids in the intestine and preventing their reabsorption into the bloodstream.
C. Colchicine.
Colchicine is wrong because it is an anti-inflammatory drug that is used to treat gout and other inflammatory conditions, not high cholesterol.
D. Cimetidine.
Cimetidine is wrong because it is a histamine H2 receptor antagonist that reduces stomach acid production and is used to treat ulcers and gastroesophageal reflux disease (GERD), not high cholesterol.
Full Explanation
Colesevelam is a bile acid sequestrant that lowers cholesterol by binding to bile acids in the intestine and preventing their reabsorption into the bloodstream. Some possible explanations for the other choices are:
Choice A. Chlorpromazine is wrong because it is an antipsychotic medication that has no effect on cholesterol levels.
Choice C. Colchicine is wrong because it is an anti-inflammatory drug that is used to treat gout and other inflammatory conditions, not high cholesterol.
Choice D. Cimetidine is wrong because it is a histamine H2 receptor antagonist that reduces stomach acid production and is used to treat ulcers and gastroesophageal reflux disease (GERD), not high cholesterol.
Normal ranges for cholesterol levels vary depending on the type of cholesterol and the risk factors of the individual, but generally, total cholesterol should be less than 200 mg/dL, LDL cholesterol should be less than 100 mg/dL, HDL cholesterol should be more than 40 mg/dL for men and 50 mg/dL for women, and triglycerides should be less than 150 mg/dL.