The new nurse is preparing to apply for a job.
Which of the following is a good reason for the nurse to prepare a résumé?

The client is at highest risk for developing Pneumocystis pneumonia due to their CD4 T-cell count.

• Pneumocystis pneumonia (PCP) is an opportunistic infection commonly seen in clients with AIDS, especially when the CD4 T-cell count drops below 200/mm³.
• This client’s CD4 count is around 198–200/mm³, placing them at high risk for PCP.
• Respiratory findings and oxygen saturation may help identify existing pneumonia but do not explain the risk as directly as CD4 count.
• Diarrhea and potassium level relate more to hydration and electrolyte balance, not directly to the risk of PCP.
• Impaired gas exchange or cardiac dysrhythmias are possible complications but secondary to infection risk from low immunity.

Choice A rationale

Colchicine does not primarily cause increased generalized bruising. Bruising is more commonly associated with medications affecting platelet function or coagulation, such as anticoagulants or antiplatelet agents. Colchicine's primary mechanism of action involves inhibiting neutrophil migration and inflammatory processes, not directly impacting hemostasis, therefore this is not an expected side effect.

Choice B rationale

Monitoring for muscle pain, or myalgia, is important for clients taking colchicine. Colchicine can cause skeletal muscle toxicity, leading to rhabdomyolysis in some individuals, particularly with higher doses or in the presence of renal impairment. Myalgia is a key symptom of muscle breakdown and should prompt further investigation, including creatine kinase (CK) levels (normal range 22-198 U/L).

Choice C rationale

Colchicine should ideally be taken with food if gastrointestinal upset, such as nausea, develops. Taking it on an empty stomach can exacerbate these side effects, which are common with colchicine due to its effects on rapidly dividing cells in the gastrointestinal tract. Consuming food helps to buffer the medication and reduce gastric irritation.

Choice D rationale

Increasing intake of grapefruit juice is contraindicated with colchicine. Grapefruit juice inhibits the cytochrome P450 3A4 (CYP3A4) enzyme system and P-glycoprotein, both of which are involved in the metabolism and excretion of colchicine. This inhibition can lead to increased plasma concentrations of colchicine, significantly raising the risk of toxicity, including severe myopathy and bone marrow suppression.