A nurse is caring for a client who is receiving long-term treatment with oral doses of prednisone. For which of the following adverse effects should the nurse monitor?

The nurse should plan to take the following actions:

A.Verify the prescription: Before administering any medication, the nurse must verify the prescription to ensure accuracy, appropriateness, and that it matches the provider's order.

Regarding option B, administering the medication at 1000, 1400, 1800, and 2200 may not be appropriate. The prescription states that ampicillin should be administered every 6 hours. The nurse should administer the medication at equally spaced intervals throughout the day. If the medication is prescribed every 6 hours, the appropriate administration times would be 0600, 1200, 1800, and 2400. However, the question does not provide sufficient information to determine the exact administration times, so option B cannot be definitively selected.

C. Assess the client for an allergy to penicillin: Since ampicillin is a penicillin-class antibiotic, it is essential for the nurse to assess the client for any history of allergies to penicillin or other beta-lactam antibiotics. A penicillin allergy could lead to a severe allergic reaction, so it is crucial to identify any potential allergies before administering the medication.

D. Document giving the medications: After administering the ampicillin, the nurse should document the administration in the client's medical record, including the time, dose, route, and any relevant observations or assessments.

E. Obtain a sputum for culture and sensitivity: The client's new prescription for ampicillin may be related to an infection. To ensure appropriate and effective treatment, obtaining a sputum specimen for culture and sensitivity is necessary. This will help identify the specific bacteria causing the respiratory infection and determine which antibiotics will be most effective in treating it.

When providing teaching to a client with chronic rheumatoid arthritis who is starting a new prescription for hydroxychloroquine, the nurse should instruct the client to obtain routine eye examinations. Hydroxychloroquine is an antimalarial and immunosuppressive medication commonly used to treat rheumatoid arthritis and other autoimmune conditions.

One of the potential side effects of hydroxychloroquine is ocular toxicity, particularly affecting the retina. Retinal toxicity can lead to vision changes or, in severe cases, irreversible damage to the eyes. Therefore, regular eye examinations are necessary to monitor for any signs of retinal toxicity and detect any visual changes early to prevent further complications.

The American Academy of Ophthalmology recommends that patients taking hydroxychloroquine undergo a baseline eye examination before starting the medication and annual eye examinations thereafter, especially after five years of continuous use.

Let's go through the other options:

B. Chest x-ray: A chest x-ray is not routinely required for monitoring clients taking hydroxychloroquine for rheumatoid arthritis. Hydroxychloroquine is not known to cause significant respiratory or pulmonary side effects.

C. Pancreatic enzyme levels: Monitoring pancreatic enzyme levels is not specifically related to hydroxychloroquine therapy. Pancreatic enzyme level testing is typically used to assess the function of the pancreas in conditions like pancreatitis or pancreatic insufficiency.

D. Urinalysis screening: While regular monitoring of kidney function is important for clients on long-term medication therapy, routine urinalysis screening is not specifically related to hydroxychloroquine use in clients with rheumatoid arthritis. Regular eye examinations are of higher priority due to the potential ocular toxicity associated with this medication.