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. Breastfeeding. Ceftriaxone is generally considered safe during breastfeeding because only a small amount is excreted in breast milk. While monitoring for gastrointestinal disturbances or thrush in the infant is advised, breastfeeding is not a contraindication for ceftriaxone use.

B. Client allergy. The client has a penicillin allergy, which raises concerns about cross-reactivity with cephalosporins, including ceftriaxone. Although the cross-reactivity rate is low, clients with a history of severe allergic reactions (e.g., anaphylaxis, angioedema, or urticaria) to penicillin should avoid cephalosporins. The nurse should clarify the nature of the penicillin allergy before administering ceftriaxone.

C. Gentamycin prescription. Ceftriaxone and gentamicin are both nephrotoxic, and using them together increases the risk of kidney damage. The client should be monitored for renal function impairment, and alternative antibiotic therapy may be considered if necessary. The nurse should discuss this potential drug interaction with the provider before administration.

D. Hematocrit. The client’s hematocrit (32%) is low but does not require withholding ceftriaxone. A slightly decreased hematocrit is expected postpartum, especially in cases of infection or recent delivery. Ceftriaxone is not known to cause significant hematologic suppression that would make this a contraindication.

E. Hemoglobin. The client’s hemoglobin (9 g/dL) is lower than normal, likely due to postpartum blood loss or infection-related inflammation. However, ceftriaxone does not directly affect hemoglobin levels, so this is not a reason to withhold the medication.

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).