A female patient is questioning the nurse on why she can’t explain the same 5-day antibiotic (Zithromax) that her husband received. The patient is 65 with a history of and has an abnormal heart rhythm. The nurse explains that:

Choice A reason: Enteral (oral) administration typically has slower absorption than intravenous routes due to first-pass metabolism in the liver and variable gastric emptying. While effective for many drugs, it’s not faster than parenteral routes, making this choice incorrect for describing the primary advantage of enteral administration.

Choice B reason: Some enteral drugs are inactivated by digestive enzymes or liver metabolism (first-pass effect), not prevented. Special formulations (e.g., enteric-coated) may protect drugs, but this isn’t a general advantage of the enteral route, which often faces enzymatic degradation, making this choice inaccurate.

Choice C reason: Enteral administration does not offer superior control of serum drug levels compared to intravenous routes, which provide precise dosing and immediate bioavailability. Oral drugs face variable absorption and first-pass metabolism, leading to less predictable levels, making this choice incorrect for enteral benefits.

Choice D reason: Enteral administration is safer (avoids injection risks like infection), less expensive (no need for sterile equipment), and more convenient (self-administered at home). These advantages make it preferable for many drugs, aligning with patient compliance and cost-effectiveness, making this the correct choice for the nurse’s response.

Choice A reason: Nighttime awakenings more than twice weekly indicate step 2, requiring maintenance therapy. Step 1 uses albuterol as needed, so this is incorrect.

Choice B reason: Twice-daily glucocorticoids are for step 2 or higher, not step 1, where albuterol is used as needed. This is incorrect for step 1 management.

Choice C reason: LABAs are used in step 3 or higher, not step 1, where albuterol alone is sufficient as needed. This is incorrect for the asthma step.

Choice D reason: At step 1, albuterol is used as a rescue inhaler for acute asthma symptoms. This is the standard approach, making it the correct choice.