A nurse is caring for a client who has a prescription for penicillin
V. Which of the following adverse effects is the priority for the nurse to monitor after the administration of the medication?

Choice A rationale

Mannitol is an osmotic diuretic that increases the osmolality of the glomerular filtrate, thereby inhibiting water reabsorption in the renal tubules. This osmotic effect leads to increased water excretion and subsequently an improved urinary output. This enhanced diuresis is a primary therapeutic goal, particularly in conditions like cerebral edema or acute renal failure.

Choice B rationale

Mannitol is not indicated for the resolution of diabetic ketoacidosis. Diabetic ketoacidosis is a metabolic emergency characterized by hyperglycemia, ketonemia, and acidosis, requiring insulin therapy, fluid resuscitation, and electrolyte management. Mannitol does not address the underlying pathophysiology of insulin deficiency.

Choice C rationale

Mannitol's mechanism of action does not directly decrease brain natriuretic peptide (BNP) levels. BNP is a hormone released by cardiomyocytes in response to ventricular stretch and is a marker of heart failure. While mannitol can reduce fluid overload, which might indirectly impact cardiac preload, its direct effect is not on BNP secretion.

Choice D rationale

Mannitol is used to decrease, not increase, intraocular pressure. Its osmotic properties draw fluid from the extravascular space, including the vitreous humor of the eye, into the vascular compartment. This reduction in fluid volume within the eye lowers intraocular pressure, making it useful in treating acute angle-closure glaucoma.

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.