A nurse is preparing to administer phenobarbital 3 mg/kg/day PO in two divided doses to a client who weighs 145 lb. The amount available is phenobarbital 100 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A. Atropine. Atropine is an anticholinergic medication used to treat bradycardia and reduce secretions before surgery. It has no effect on reversing anticoagulation caused by heparin and would not be an appropriate treatment for heparin overdose.

B. Vitamin K. Vitamin K is used as an antidote for warfarin toxicity, as it helps produce clotting factors that warfarin inhibits. However, it does not reverse the effects of heparin, which works by enhancing the activity of antithrombin to prevent clot formation.

C. Vitamin B12. Vitamin B12 is essential for red blood cell production and neurological function, primarily used to treat conditions like pernicious anemia. It does not have any role in reversing the anticoagulant effects of heparin and would not be beneficial in this situation.

D. Protamine. Protamine sulfate is the specific antidote for heparin overdose. It binds to heparin, neutralizing its anticoagulant effects and preventing excessive bleeding. Protamine is administered intravenously in cases of heparin toxicity or when urgent reversal is needed, such as before surgery or in cases of uncontrolled bleeding.

A. "I can discontinue this medication after one negative sputum culture." Treatment for tuberculosis requires a long-term regimen lasting at least 6 months, even if the sputum culture becomes negative. Discontinuing rifampin too early increases the risk of drug resistance and treatment failure. The client must continue therapy as prescribed and complete the full course.

B. "I should take this medication on an empty stomach." Rifampin should be taken on an empty stomach (1 hour before or 2 hours after meals) to improve absorption and effectiveness. Food can reduce the bioavailability of the drug, making it less effective in treating tuberculosis. If gastrointestinal discomfort occurs, the client should consult their provider before making adjustments.

C. "I should expect to have ringing in my ears." Tinnitus (ringing in the ears) is not a common side effect of rifampin. Ototoxicity is more commonly associated with aminoglycosides (e.g., streptomycin) or vancomycin. Rifampin’s notable side effects include hepatotoxicity, red-orange discoloration of body fluids, and gastrointestinal disturbances.

D. "I can expect to have joint pain." While rifampin can cause mild flu-like symptoms, including fatigue and muscle aches, persistent joint pain is not a typical side effect. If joint pain occurs, it may be related to another condition, such as drug-induced hepatotoxicity or an adverse reaction to other tuberculosis medications (e.g., pyrazinamide, which can cause gout-like symptoms).