A patient who is HIV-positive has been receiving medication therapy that includes zidovudine.

The prescriber has decided to stop the zidovudine due to its dose-limiting adverse effect.

Which of these conditions is the dose-limiting adverse effect of zidovudine therapy?

The correct answer is Choice D.

Let’s go through the calculations step by step:

Step 1: Convert all the quantities to milliliters (mL), as the nurse needs to record the intake in mL. We know that 1 oz is approximately 29.5735 mL.

4 oz of juice = 4 × 29.5735 mL = 118.294 mL

6 oz of tea = 6 × 29.5735 mL = 177.861 mL 8 oz of broth = 8 × 29.5735 mL = 236.628 mL Step 2: Add all the quantities together:

118.294 mL (juice) + 177.861 mL (tea) + 100 mL (soda) + 150 mL (IV bolus) + 236.628 mL (broth) = 783.783 mL Step 3: Round off the total intake to the nearest whole number as required, which gives us 784 mL.

Therefore, the nurse should record 784 mL on the patient’s chart. However, this option is not available in the choices given. The closest option to this calculated value is 800 mL (Choice D).

Now, let’s discuss the rationales for each choice:

Choice A rationale:

500 mL would be an underestimate of the patient’s fluid intake. It does not account for all the fluids the patient consumed.

Choice B rationale:

600 mL, similar to Choice A, is an underestimate. It does not accurately represent the total volume of fluids the patient consumed. Choice C rationale:

700 mL is closer to the calculated intake but is still an underestimate. It does not fully account for all the fluids the patient consumed.

Choice D rationale:

800 mL is the closest option to the calculated intake of 784 mL. Although it’s slightly over the actual intake, it’s the best choice among the given options.

Choice A rationale:

Instructing the client to soak his feet daily is not recommended for individuals with diabetes. Soaking the feet can increase the risk of foot problems, particularly if the person has nerve damage or poor blood flow. It can lead to dry and cracked skin, which can increase the risk of infection. Therefore, this intervention should not be included in the care plan.

Choice B rationale:

Assisting the client in developing an individualized meal plan is a crucial intervention for managing type 2 diabetes. Meal planning is the first step in healthy eating and is especially important for people with diabetes because food directly impacts blood glucose levels. An individualized meal plan considers the person’s goals, tastes, lifestyle, and any medicines they’re taking. Therefore, this intervention should be included in the care plan.

Choice C rationale:

Checking the client’s blood glucose level before meals and at bedtime is an essential part of managing diabetes. Regular monitoring of blood glucose levels can help track the effect of diabetes medicines, understand how diet and exercise affect blood glucose levels, and detect if blood glucose levels are high or low. Therefore, this intervention should be included in the care plan.

Choice D rationale:

Administering an extra dose of insulin if the client’s blood glucose level drops to 50 mg/dl is not recommended. If a person’s blood glucose level is already low, administering additional insulin can lead to an insulin overdose, which can be lifethreatening. Therefore, this intervention should not be included in the care plan.