A patient with a viral infection is to receive ganciclovir (Cytovene) 5 mg/kg/day IVPB every morning.

The patient weighs 110 pounds.

Identify how many milligrams this patient will receive for this dose.

Choice A rationale

Cromolyn is a mast cell stabilizer that works by inhibiting the release of inflammatory mediators (e.g., histamine, leukotrienes) from mast cells. Its mechanism of action is prophylactic, meaning it prevents the cellular cascade leading to bronchospasm when administered before exposure to a trigger, such as exercise. It has no bronchodilatory effect.

Choice B rationale

Administering cromolyn at the initial onset of an attack is ineffective because it does not have acute bronchodilatory properties. Once the inflammatory cascade is initiated and bronchoconstriction has begun, cromolyn cannot reverse the symptoms. Rescue inhalers like albuterol are needed for acute symptom relief.

Choice C rationale

Cromolyn is a prophylactic medication and does not provide symptomatic relief during an acute asthma attack. Its role is to stabilize mast cells to prevent the release of inflammatory mediators that cause bronchoconstriction and inflammation. Therefore, it is not used to alleviate symptoms once an attack is in progress.

Choice D rationale

While cromolyn can be prescribed for regular daily use, the specific instruction for exercise-induced asthma is to take it before exercise. Taking it as often as 4 times a day without considering the timing relative to triggers may not be optimal for preventing exercise-induced symptoms, as its effect is primarily preventive.

Choice A rationale

Oral rinsing after fluticasone administration helps prevent oral candidiasis by removing residual corticosteroid, but if lesions are already present, this action alone is insufficient. It is a preventive measure, not a treatment for existing fungal or other infections causing lesions.

Choice B rationale

Oral lesions in a client on fluticasone, an inhaled corticosteroid, are highly suggestive of oral candidiasis (thrush) due to local immunosuppression. Obtaining a culture and sensitivity identifies the specific pathogen and its susceptibility to antifungal agents, guiding appropriate and effective treatment. Normal flora includes Candida albicans, but overgrowth leads to infection.

Choice C rationale

Starting a broad-spectrum antibiotic is inappropriate without identifying the causative agent. Oral lesions are more commonly fungal in origin in this context, not bacterial. Unnecessary antibiotic use can lead to antibiotic resistance and disrupt normal flora, potentially worsening a fungal infection.

Choice D rationale

While oral candidiasis is a known side effect of inhaled corticosteroids, simply documenting the finding without further action would be negligent. Prompt identification and treatment of the infection are necessary to prevent discomfort, spread, and potential complications, ensuring the client's well-being.