A client with gout in the left great toe has received a prescription for prednisone 30 mg by mouth to be administered each day.
Which symptom is most important for the client to report to the healthcare provider?

Choice A rationale
A potassium level of 4.4 mEq/L (4.4 mmol/L) is within the normal range. Potassium is a critical electrolyte in the body, playing key roles in cellular metabolism, protein synthesis, and electrical action potential regulation across cell membranes. Normal potassium levels typically range from 3.5 to 5.1 mmol/L1. Therefore, a potassium level of 4.4 mEq/L indicates that the patient’s potassium level is within the normal range, which is a safe condition for the administration of vancomycin.
Choice B rationale

The use of antibiotics for prophylaxis, or prevention, is a common practice in healthcare, particularly in surgical procedures such as pacemaker insertion. This is done to prevent potential infections that could occur during or after the procedure. Vancomycin is a type of antibiotic that is often used for prophylaxis against infections caused by gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA)3. Therefore, if the antibiotic is being used for prophylaxis, it would be safe to administer vancomycin.
Choice C rationale
A blood urea nitrogen (BUN) level of 17 mg/dL (6.07 mmol/L) is within the normal range. The BUN test measures the amount of urea nitrogen in the blood, which can provide important information about kidney function. Urea nitrogen is a waste product that is created in the liver when protein is metabolized. It is then transported through the blood to the kidneys, which filter out most of the urea nitrogen, leaving a small amount in the blood. Normal BUN levels typically range from 6 to 20 mg/dL4. Therefore, a BUN level of 17 mg/dL indicates that the patient’s kidney function is within the normal range, which is a safe condition for the administration of vancomycin.
Choice E rationale
The absence of known allergies in a patient is a crucial factor in determining the safety of administering any medication, including vancomycin. Allergic reactions to medications can range from mild symptoms such as rash and itching to severe and life-threatening conditions such as anaphylaxis. Therefore, if a patient has no known allergies, it would be safe to administer vancomycin.
Choice D rationale

While it’s true that the dosage of the antibiotic should be within the safe range, the specific dosage of vancomycin for the patient isn’t provided in the question. Therefore, we cannot definitively say that this condition is met based on the information given.
Choice F rationale
Although vancomycin can be administered via a peripheral IV in a large vein, it’s important to note that vancomycin has a low pH and may cause venous irritation and tissue damage in cases of extravasation. Therefore, while it’s possible to administer vancomycin this way, it’s not necessarily an indicator of safety.

Choice A rationale
Gastric lavage is a procedure that involves the insertion of a tube into the stomach to remove its contents and is typically used in cases of poisoning or drug overdose. However, it should not be the first action taken. The type of chemical exposure needs to be determined first to guide appropriate treatment.
Choice B rationale
Determining the type of chemical exposure is crucial as it guides the subsequent steps in management. Different chemicals can have different effects on the body and require different treatments.
Choice C rationale
While assessing for altered sensorium is important in a child exposed to chemicals, it is not the first action. The nurse needs to identify the type of chemical the child was exposed to in order to anticipate potential complications and guide treatment.
Choice D rationale

Calling the poison control emergency number is an important step in managing a case of chemical exposure. However, having information about the type of chemical the child was exposed to can make this call more effective.