A nurse is preparing to administer azithromycin 30 mg/kg PO to a child who has otitis media. The child weighs 20 kg (44.1 lb). The amount available is azithromycin 200 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Prednisone is a synthetic glucocorticoidused to suppress airway inflammation in chronic asthma. It inhibits the migration of polymorphonuclear leukocytesand reverses increased capillary permeability. Significant side effects arise from its immunosuppressiveproperties and its impact on glucose metabolism and bone density during prolonged therapy.

Rationale:

A.Signs of infection are a primary concern for patients on prednisone because glucocorticoids suppress the immune system and mask early inflammatory symptoms. The drug inhibits the activity of white blood cells, making it difficult for the body to fight pathogens. The nurse must instruct the client to report even low-grade fevers or sore throats immediately to prevent systemic spread.

B.Urinary frequency is not a direct adverse effect of prednisone, although the drug can cause secondary hyperglycemia. While excessive glucose in the urine might eventually cause polyuria, it is not the hallmark side effect a patient should prioritize. The instruction should focus more on the direct risks of corticosteroid therapy, such as fluid retention and electrolyte imbalances like hypokalemia.

C.Low blood pressure is not expected with prednisone therapy; instead, glucocorticoids often cause sodium and water retention, leading to hypertension. Prednisone increases the sensitivity of vascular smooth muscle to catecholamines, which can elevate systemic vascular resistance. Monitoring for weight gain and peripheral edema is more relevant than watching for hypotension in this clinical context.

D.Skin inflammation is actually treated by prednisone rather than caused by it, as the medication is a potent anti-inflammatory. However, long-term use can lead to skin thinning, ecchymosis, and delayed wound healing. The nurse should clarify that while the drug reduces inflammation, it weakens the integrity of the dermal layers, making the skin more fragile and prone to injury.

Phenytoin is a hydantoin anticonvulsantthat stabilizes neuronal membranes by delaying the influx of sodium ions during action potentials. It has a narrow therapeutic indexand significant effects on cardiac conduction, specifically lengthening the refractory period. Due to its potential to depress myocardial automaticity, it is strictly avoided in patients with certain pre-existing conduction system abnormalities.

Rationale:

A.Sinus bradycardia is a major contraindication for phenytoin because the drug can further depress cardiac conduction and automaticity. Phenytoin possesses class IB antiarrhythmic properties, which can lead to severe cardiovascular collapse or heart block in patients with slow heart rates. Administering this drug to a bradycardic patient poses a life-threatening risk of asystole.

B.A history of cholecystitis, or inflammation of the gallbladder, does not contraindicate the use of phenytoin for seizure management. While phenytoin is metabolized by the liver, it does not have a direct impact on gallbladder function or the formation of gallstones. The nurse would prioritize monitoring liver enzymes rather than focusing on a history of cholecystitis.

C.Taking vitamin B12 supplements does not prevent a patient from receiving phenytoin, as there is no dangerous interaction between the two. Interestingly, long-term phenytoin use is actually associated with folate deficiency rather than issues with B12. Supplements are generally safe and may be necessary for patients with concurrent nutritional deficiencies during anticonvulsant therapy.

D.Ibuprofen is a non-steroidal anti-inflammatory drug that does not have a documented clinical contraindication with the administration of phenytoin. While phenytoin has many drug-drug interactions involving the cytochrome P450 system, ibuprofen is not typically one that causes toxicity. The nurse can safely administer both medications as long as standard monitoring is performed.