A nurse is preparing to administer azithromycin 30 mg/kg PO to a child who has otitis media. The child weighs 20 kg (44.1 lb). The amount available is azithromycin 200 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Methimazole is an antithyroidagent that inhibits the enzyme thyroid peroxidase, preventing the iodination of tyrosine and the synthesis of T3 and T4. It is used to manage hyperthyroidismby shifting the patient from a hypermetabolic state back toward a euthyroid physiological balance.

Rationale:

A.Weight loss is a clinical manifestation of the hyperthyroidism seen in Graves' disease, not an expected therapeutic effect of methimazole. As the medication successfully lowers thyroid hormone levels, the client's basal metabolic rate slows down, typically resulting in weight gain or stabilization. The nurse should expect the client to stop losing weight as the treatment becomes effective.

B.An increase in pulse rate is a symptom of untreated hyperthyroidism due to the stimulatory effects of excess thyroid hormones on the cardiovascular system. Methimazole therapy should result in a decrease in heart rate as the metabolic demand lessens. If the pulse remains high, it may indicate that the dosage is not yet sufficient to control the disease.

C.Increased sleeping is an expected therapeutic outcome because methimazole reduces the hypermetabolic state that causes insomnia and restlessness in Graves' disease. As thyroid hormone levels normalize, the client's central nervous system activity decreases, allowing for more restorative rest. This shift indicates that the medication is successfully reversing the thyrotoxicosis and bringing the patient toward a euthyroid state.

D.Warmer skin and heat intolerance are classic signs of hyperthyroidism caused by increased thermogenesis. Methimazole works to lower the body's metabolic rate, which should result in cooler skin and an improved tolerance to ambient temperatures. If the skin remains excessively warm and moist, the client may still be in a hyperthyroid state requiring further titration of the medication.

Gemfibrozil is a fibrateused to treat hypertriglyceridemiaby activating peroxisome proliferator-activated receptor-alpha. It reduces very-low-density lipoprotein levels but can cause significant gastrointestinal distressand hepatobiliary complications. A critical risk includes the development of cholelithiasis or myopathy, especially when the medication is administered concurrently with certain other lipid-lowering agents.

Rationale:

A.Tinnitus, or ringing in the ears, is not a recognized or common adverse effect associated with gemfibrozil therapy. This symptom is more frequently linked to ototoxic medications like aminoglycosides or high-dose aspirin. Patients taking fibrates are not generally monitored for auditory changes as part of the standard safety profile for this drug class.

B.A decreased LDL level is a therapeutic goal and expected outcome of lipid-lowering therapy, not an adverse effect. Gemfibrozil is primarily indicated to lower triglycerides and increase HDL, though it may also modestly lower LDL. Reporting a desired clinical improvement would not be necessary in the context of identifying harmful medication reactions.

C.Epigastric pain must be reported because gemfibrozil can cause biliary stasis, increasing the risk of gallstones and cholecystitis. It can also cause generalized dyspepsia and, in more severe cases, contribute to pancreatitis. If a client experiences upper abdominal pain, the nurse must assess for potentially serious hepatobiliary or pancreatic complications immediately.

D.Weight gain is not a typical side effect of gemfibrozil; in fact, the medication does not significantly impact adipose tissue accumulation. Most gastrointestinal side effects of fibrates involve nausea or abdominal discomfort, which would more likely lead to a decrease in appetite. Unexplained weight gain would require investigation into other metabolic or cardiac etiologies.