A client receives a prescription for penicillin 1.2 million units IM. The available vial is labeled, “600,000 units/mL.” How many mL should the nurse administer? (Enter numeric value only.)

Choice A reason:

Instructing the client to obtain a prescription for oral terbinafine is the most appropriate action. Oral terbinafine is an antifungal medication that is effective in treating fungal infections of the toenails. It works by inhibiting the growth of fungi, leading to the resolution of the infection. Topical treatments are often insufficient for toenail fungal infections because they do not penetrate the nail bed effectively.

Choice B reason:

Advising the client to obtain a prescription-strength formulation of the ointment is not the best approach. While prescription-strength topical antifungals can be more effective than OTC options, they still may not penetrate the nail bed adequately to treat the infection. Oral antifungals are generally more effective for toenail infections.

Choice C reason:

Suggesting that the client use the ointment twice a day to be more effective is not recommended. Increasing the frequency of application of an ineffective treatment is unlikely to yield better results. The client needs a more effective treatment option, such as an oral antifungal.

Choice D reason:

Reassuring the client that treatment of fungus-infected toenails often takes several months is true but does not address the issue of using an ineffective treatment. While it is important to set realistic expectations about the duration of treatment, the client needs to be directed towards a more effective treatment option.

Choice A reason:

Requesting a prescription to change the route of administration and use the available heparin is not appropriate. Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are not interchangeable on a unit-for-unit basis. They have different pharmacokinetics and dosing requirements. Changing the route without proper guidance can lead to incorrect dosing and potential complications.

Choice B reason:

Calculating and administering the equivalent dose of the available low molecular weight heparin is incorrect. LMWH and UFH have different dosing protocols and are not directly interchangeable. Administering LMWH instead of UFH without proper conversion and guidance can result in inappropriate anticoagulation.

Choice C reason:

Diluting the available heparin in 250 ml of normal saline solution prior to IV administration is not appropriate. The prescription specifies heparin 5000 units IV STAT, which indicates an immediate need for intravenous administration. Diluting and administering it in this manner does not align with the urgency of the order.

Choice D reason:

Advising the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately is the correct action. This ensures that the client receives the prescribed medication in the correct form and dosage as ordered by the healthcare provider. It is crucial to follow the specific instructions for heparin administration to ensure patient safety and effective anticoagulation.