The health care provider prescribes the antibiotic tetracycline HCl for an adult client who arrived at an outpatient clinic. Which instruction should the nurse include in the teaching plan for this client?

Choice A reason: Decreasing pain and burning during urination is not the purpose of probenecid, which is a drug that lowers the level of uric acid in the blood. Probenecid is used to treat gout, a condition that causes painful inflammation of the joints due to the accumulation of uric acid crystals. Probenecid does not have any effect on the urinary tract or its symptoms.

Choice B reason: Increasing the strength of the urine stream is not the purpose of probenecid, which is a drug that increases the amount of uric acid in the urine. Probenecid works by blocking the reabsorption of uric acid by the kidneys, thus increasing its excretion. Probenecid does not have any effect on the bladder or its function.

Choice C reason: Preventing the formation of kidney stones is not the purpose of probenecid, which is a drug that can actually increase the risk of kidney stones. Probenecid increases the concentration of uric acid in the urine, which can lead to the formation of uric acid stones. The nurse should instruct the client to drink plenty of fluids and avoid foods high in purines, such as organ meats, seafood, and alcohol, to prevent kidney stones.

Choice D reason: Promoting excretion of uric acid in the urine is the purpose of probenecid, which is a drug that reduces the level of uric acid in the blood. Probenecid helps prevent gout attacks by preventing the buildup of uric acid crystals in the joints. The nurse should monitor the client's serum uric acid level, renal function, and urine output, and advise the client to take the medication with food to avoid stomach upset.

Choice A reason: Employed as a construction worker is not the most important assessment finding for the nurse to address. Although the client's occupation may expose them to moist and warm environments that can promote fungal growth, it is not directly related to the administration of terbinafine HCL. The nurse should advise the client to wear breathable shoes and socks and keep the feet dry and clean, but it is not a priority.

Choice B reason: Reported history of alcoholism is the most important assessment finding for the nurse to address. Terbinafine HCL can cause hepatotoxicity, especially in clients with pre-existing liver disease or who consume alcohol regularly. The nurse should assess the client's liver function tests and alcohol intake before starting the medication and inform the prescriber accordingly. The nurse should also monitor the client for signs and symptoms of liver damage, such as jaundice, abdominal pain, nausea, or fatigue.

Choice C reason: White blood cell count of 8,500/mm3 (8.5 x 10^9/L) is not the most important assessment finding for the nurse to address. This value is within the normal reference range of 5,000 to 10,000/mm3 (5 to 10 x 10^9/L) and does not indicate any infection or inflammation. The nurse should check the client's baseline blood counts before starting the medication, but it is not a priority.

Choice D reason: Toenails appear thick and yellow is not the most important assessment finding for the nurse to address. This is a typical manifestation of a fungal toenail infection, which is the indication for terbinafine HCL. The nurse should expect the toenails to improve in appearance and texture after the completion of the treatment, which may take several weeks or months. The nurse should educate the client about the expected outcomes and adherence to the medication regimen, but it is not a priority.