A patient is admitted with a fever of 102.8°F (39.3°C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence?

Choice A reason: Montelukast, a leukotriene receptor antagonist, is not typically tapered or discontinued when symptoms improve. It is used for chronic asthma management to prevent exacerbations by blocking leukotriene-mediated inflammation. Discontinuing it prematurely may lead to symptom recurrence, as it does not provide acute relief.

Choice B reason: Montelukast is an oral medication, not an inhaler, so inhalation technique is irrelevant. It blocks leukotriene D4 receptors to reduce airway inflammation and bronchoconstriction. Proper administration involves daily oral dosing, and no inhalation device is required, making this instruction incorrect for montelukast.

Choice C reason: Montelukast is not used for acute asthma attacks, as its onset is too slow (hours to days). It is a maintenance therapy that prevents inflammation, not a rescue medication like albuterol. Patients should carry short-acting beta-agonists, not montelukast, for acute symptom relief.

Choice D reason: Montelukast must be taken daily on a continuous schedule to maintain its anti-inflammatory effects by blocking leukotriene receptors, even if asthma symptoms improve. Consistent use prevents exacerbations and maintains airway stability, as its mechanism relies on sustained leukotriene inhibition to control chronic asthma symptoms effectively.

Choice A reason: Penicillin antibiotics, like amoxicillin, inhibit bacterial cell wall synthesis and are not associated with photosensitivity. Their side effects include allergic reactions and gastrointestinal upset. Photosensitivity requires drugs that absorb UV light, altering skin response, which is not a mechanism of penicillin’s action on bacterial peptidoglycan.

Choice B reason: Cephalosporins, similar to penicillins, target bacterial cell walls and are not commonly linked to photosensitivity. Their side effects include hypersensitivity and gastrointestinal issues. Unlike drugs that cause phototoxic reactions by absorbing UV light, cephalosporins lack chromophores that trigger skin photosensitivity, making this incorrect.

Choice C reason: Tetracyclines, like doxycycline, are known to cause photosensitivity by forming phototoxic compounds under UV light exposure. These compounds generate reactive oxygen species, damaging skin cells and causing exaggerated sunburn or rashes. Patients must avoid sun exposure and use sunscreen to prevent this adverse effect during therapy.

Choice D reason: Vancomycin, used for gram-positive infections, inhibits cell wall synthesis but is not associated with photosensitivity. Its primary side effects include nephrotoxicity and red man syndrome. It does not absorb UV light or form phototoxic metabolites, making it an unlikely cause of skin reactions to sunlight.