A nurse is completing a home care visit for a 75-year-old client who began enoxaparin sodium (Lovenox) therapy 2 weeks ago.

The nurse is providing teaching regarding managing a bleeding episode in the event of an accidental injury with the client and his spouse.

Which of the following statements by the spouse indicates a need for further teaching?

Choice A rationale

The recommended first-line treatment for uncomplicated gonorrhea is typically a single 500 mg intramuscular (IM) injection of Ceftriaxone, a third-generation cephalosporin. This regimen is highly effective because Ceftriaxone achieves high, sustained serum and tissue levels and addresses the increasing rates of antimicrobial resistance seen in Neisseria gonorrhoeae, providing a reliable, single-dose cure to both the client and their partner.

Choice B rationale

Doxycycline is primarily used to treat Chlamydia trachomatis infection, which frequently co-occurs with gonorrhea. While it may be administered alongside Ceftriaxone for dual coverage if chlamydia hasn't been ruled out, it is not the monotherapy for gonorrhea, which requires the higher efficacy of a cephalosporin like Ceftriaxone due to resistance patterns.

Choice C rationale

Penicillin is no longer the standard treatment for gonorrhea because Neisseria gonorrhoeae has developed widespread resistance to penicillins and many other older antibiotics through plasmid-mediated β-lactamase production and chromosomal mutations. Using a single dose of Penicillin would likely result in treatment failure and the progression of the infection, thus necessitating the use of the more potent Ceftriaxone.

Choice D rationale

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae and is a serious sexually transmitted infection (STI) that requires prompt antibiotic treatment. It does not typically resolve on its own. Untreated infection can lead to severe complications, including pelvic inflammatory disease (PID) in women, epididymitis in men, and potentially disseminated gonococcal infection (DGI), highlighting the necessity of effective treatment.

Choice A rationale

Hydrochlorothiazide is a thiazide diuretic that works by inhibiting sodium and chloride reabsorption in the distal convoluted tubule. This mechanism causes increased excretion of both water and potassium, making the client susceptible to hypokalemia (serum potassium <3.5 mEq/L), not hyperkalemia, thereby requiring regular electrolyte monitoring.

Choice B rationale

Furosemide is a potent loop diuretic that acts on the ascending limb of the loop of Henle, blocking the reabsorption of sodium, chloride, and potassium. Its high efficacy in causing diuresis leads to significant renal loss of potassium, which places the client at a high risk for developing hypokalemia (serum potassium <3.5 mEq/L), not the elevated levels of hyperkalemia.

Choice C rationale

Mannitol is an osmotic diuretic that acts primarily by increasing the osmotic pressure of the glomerular filtrate, which inhibits the reabsorption of water. It is predominantly used for reducing cerebral edema and intraocular pressure; it does not significantly interfere with the renal tubular handling of potassium, so it poses little risk for hyperkalemia.

Choice D rationale

Spironolactone is a potassium-sparing diuretic that functions as an aldosterone receptor antagonist in the distal nephron. By blocking aldosterone's effects, it promotes sodium and water excretion while retaining potassium, which, especially in clients with impaired kidney function, significantly elevates the risk for life-threatening hyperkalemia (serum potassium >5.0 mEq/L). 80mm.5pt.