A nurse is caring for a client who has a prescription for acyclovir IV three times daily.
Which of the following actions should the nurse take?

Choice A rationale

Distribution refers to the reversible movement of a drug from the systemic circulation to the body's tissues. While food can indirectly influence distribution by altering blood flow or protein binding, its primary and most direct impact on drug pharmacokinetics is not typically on the distribution phase itself.

Choice B rationale

Metabolism, primarily occurring in the liver, involves the biochemical modification of drugs. While some foods can induce or inhibit metabolic enzymes, the direct and immediate effect of the presence of food at the time of administration is typically not on the rate of drug metabolism but rather on the initial entry into the systemic circulation.

Choice C rationale

Excretion is the elimination of drugs from the body, mainly through the kidneys. Food generally does not directly influence the rate of drug excretion, which is primarily dependent on renal function, glomerular filtration, tubular secretion, and reabsorption processes.

Choice D rationale

Absorption is the process by which a drug moves from its site of administration into the bloodstream. The presence of food in the gastrointestinal tract can significantly alter the rate and extent of oral drug absorption by affecting gastric emptying time, pH, drug solubility, and interaction with food components.

Choice A rationale

Amiodarone is known to cause various adverse effects, but ototoxicity leading to hearing impairment is not a commonly reported or significant side effect. The primary concerns with amiodarone involve pulmonary, thyroid, hepatic, and ocular toxicities. Therefore, routine hearing screenings are not a standard intervention in the care plan for clients on amiodarone.

Choice B rationale

An increase in appetite is not a recognized or common adverse effect associated with amiodarone. Amiodarone can cause gastrointestinal side effects such as nausea, vomiting, and anorexia, but an increased appetite is not typically observed. Monitoring for such a symptom would not be a priority in the client's plan of care.

Choice C rationale

Amiodarone is extensively metabolized by the liver and is known to cause hepatotoxicity, ranging from asymptomatic transaminase elevation to severe hepatitis and cirrhosis. Therefore, periodic monitoring of liver enzyme levels (e.g., AST, ALT, alkaline phosphatase) is crucial to detect early signs of liver injury and adjust treatment if necessary. Normal AST levels are typically 10-40 U/L, and ALT levels are 7-56 U/L.

Choice D rationale

While some medications can cause psychiatric disturbances, manic behavior is not a commonly reported or characteristic adverse effect of amiodarone. The central nervous system effects of amiodarone are more likely to include peripheral neuropathy, ataxia, and tremors. Monitoring for manic behavior is not a standard intervention for clients on amiodarone therapy.