A nurse is assessing a client who has a positive Trousseau's sign.
Which of the following medications should the nurse plan to administer?

Choice A rationale

Jaundice is a serious indicator of hepatotoxicity, a known and potentially severe adverse effect of rifampin. It signifies liver dysfunction and requires immediate medical attention. Therefore, stating that jaundice is harmless demonstrates a critical misunderstanding of the medication's potential risks and the need for prompt reporting to the healthcare provider.

Choice B rationale

Rifampin is known to cause discoloration of body fluids, including urine, sweat, tears, and saliva, due to its reddish-orange pigment. This discoloration can permanently stain soft contact lenses. Therefore, a client's statement about not wearing soft contact lenses indicates an understanding of this specific and important adverse effect.

Choice C rationale

Rifampin absorption is reduced when taken with food. To maximize its bioavailability and effectiveness, rifampin should be taken on an empty stomach, typically one hour before or two hours after a meal. Taking it when the stomach is full would decrease its therapeutic efficacy, indicating a misunderstanding of the teaching.

Choice D rationale

Rifampin is metabolized by the liver, and alcohol consumption also places a significant metabolic burden on the liver. Concurrent use of rifampin and alcohol significantly increases the risk of hepatotoxicity, which can lead to severe liver damage. Therefore, drinking alcohol while on rifampin is strongly contraindicated and shows a lack of understanding. .

Choice A rationale

Acyclovir is primarily excreted renally, and its metabolism can lead to crystal formation in the renal tubules, particularly if the client is dehydrated or the infusion is too rapid. Monitoring for an increase in creatinine (normal range 0.6-1.2 mg/dL) is crucial as it indicates decreased glomerular filtration rate and potential nephrotoxicity or acute kidney injury, necessitating dose adjustment or hydration.

Choice B rationale

Administering oxygen prophylactically is not a standard or scientifically indicated action for acyclovir administration. Acyclovir does not inherently cause respiratory depression or compromise oxygenation. Its primary adverse effects are typically related to renal function, central nervous system, or gastrointestinal system, not respiratory compromise.

Choice C rationale

While some antiviral medications can affect hematopoiesis, acyclovir is not commonly associated with significant decreases in hemoglobin (normal range 12-18 g/dL) and hematocrit (normal range 37-52%). These parameters are generally monitored in clients with pre-existing hematological conditions or those on long-term, high-dose therapy, but it's not a primary immediate concern for IV administration.

Choice D rationale

Administering acyclovir IV over 30 minutes is the recommended infusion duration. Rapid intravenous infusion can increase the risk of renal tubular damage and crystal formation, leading to nephrotoxicity. A slower infusion rate allows for proper dilution and minimizes the concentration of the drug in the renal tubules, thus protecting kidney function and reducing adverse effects.