A nurse is preparing to administer ampicillin/sulbactam 1.5 g via intermittent IV bolus.

Available is ampicillin/sulbactam 1.5 g in 0.9% sodium chloride 100 mL to infuse over 30 min.

The nurse should set the IV infusion pump to deliver how many mL/hr? (Round the answer to the nearest whole number.

Use a leading zero if it applies.

Do not use a trailing zero.)

Choice A rationale

Alendronate is a bisphosphonate medication used to treat osteoporosis. It is known to be highly irritating to the esophageal mucosa, and if it lodges in the esophagus, it can cause severe esophagitis, ulceration, or erosion. Assessing the client's ability to swallow ensures safe passage of the medication and minimizes the risk of esophageal injury, highlighting a critical safety measure.

Choice B rationale

Alendronate should not be administered before bed. For optimal absorption and to minimize the risk of esophageal irritation, alendronate must be taken in the morning upon waking, at least 30 minutes before the first food, beverage, or medication. Taking it before bed increases the likelihood of the pill lingering in the esophagus, leading to irritation and potential injury.

Choice C rationale

Alendronate should not be administered with orange juice. The absorption of alendronate is significantly impaired by food, beverages other than plain water, and certain minerals like calcium. Orange juice contains calcium and can decrease the bioavailability of the medication, thereby reducing its therapeutic effectiveness. It must be taken with plain water only.

Choice D rationale

Informing the client to remain supine after taking the medication is incorrect. To facilitate rapid transit to the stomach and minimize esophageal contact, clients must remain upright (sitting or standing) for at least 30 minutes after taking alendronate, and until after their first food of the day. Lying down increases the risk of esophageal reflux and irritation.

Choice A rationale

Beclomethasone is an inhaled corticosteroid. Gargling with water after use is essential to reduce the local deposition of the medication in the oropharynx. This minimizes the risk of developing oral candidiasis, commonly known as thrush, and hoarseness, which are common local side effects associated with inhaled corticosteroid use.

Choice B rationale

Beclomethasone, like most inhaled suspensions, requires shaking prior to use. Shaking ensures that the medication is evenly dispersed within the propellant or solution. This uniform dispersion is critical for delivering an accurate and consistent dose with each actuation, maximizing therapeutic efficacy and minimizing variability.

Choice C rationale

Beclomethasone is a long-acting inhaled corticosteroid used for the *maintenance* and *preventive* treatment of asthma. It works by reducing airway inflammation over time, not by providing immediate bronchodilation. Therefore, it is ineffective for and should not be used during an acute asthma attack, which requires a rapid-acting bronchodilator.

Choice D rationale

For optimal benefit, the short-acting bronchodilator, albuterol, should be used *before* beclomethasone. Albuterol opens the airways, allowing for better penetration of the inhaled corticosteroid into the lower respiratory tract. This sequential administration enhances the delivery and absorption of beclomethasone, improving its anti-inflammatory effects.