hard · NCLEX-RN pharmacology

A 62-year-old female with relapsed multiple myeloma received her first step-up dose of teclistamab, a bispecific T-cell engager monoclonal antibody, 24 hours ago. The nurse notes the client has become newly confused and is shivering. Vital signs are: temperature 39.4°C (102.9°F), blood pressure 88/48 mmHg, heart rate 122 beats/min, respiratory rate 24 breaths/min, and SpO2 90% on room air. The client's platelet count is 32,000/mm3 (32 x 10^9/L). Which actions should the nurse perform immediately? Select all that apply.

1. Request a prescription to permanently discontinue teclistamab therapy.
2. Initiate continuous telemetry and pulse oximetry monitoring.
3. Administer oral ibuprofen 400 mg every 6 hours as needed for the fever.
4. Administer the ordered tocilizumab 8 mg/kg intravenously over 1 hour.
5. Place the client in a flat, supine position with the head of the bed lowered.
6. Infuse the ordered 500 mL bolus of normal saline intravenously over 30 minutes.

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