Which client information should the practical nurse (PN) obtain prior to preparing a dose of the influenza vaccine?

Choice A reason: Avoiding grapefruit juice is correct, as it inhibits CYP3A4, an enzyme metabolizing itraconazole, potentially increasing drug levels and toxicity. This shows understanding, as grapefruit juice can alter the drug’s pharmacokinetics, leading to adverse effects. No additional instruction is needed for this statement.

Choice B reason: Taking itraconazole with antacids reduces its absorption, as it requires an acidic stomach environment for optimal bioavailability. Antacids neutralize gastric acid, decreasing drug efficacy. This statement indicates a misunderstanding, necessitating further instruction to ensure effective antifungal treatment.

Choice C reason: Monitoring stool color changes is reasonable, as itraconazole can cause hepatotoxicity, potentially altering stool appearance due to liver dysfunction. This shows awareness of side effects, requiring no additional instruction, as it aligns with monitoring for adverse hepatic effects.

Choice D reason: Reporting breathing difficulty is appropriate, as itraconazole may rarely cause pulmonary side effects or exacerbate heart failure. This indicates understanding of serious adverse effects, requiring no further instruction, as it reflects vigilance for critical symptoms needing medical attention.

Choice A reason: Suggesting a snack after administering an incorrect insulin dose risks hypoglycemia, as 2 extra units can excessively lower blood glucose. Insulin dosing must match the glucose level per the sliding scale to prevent adverse effects, making this choice unsafe and reactive.

Choice B reason: Repeating the glucose level is unnecessary if the recorded level is reliable. The error lies in the drawn dose, not the glucose measurement. Correcting the dose to match the recorded glucose is more direct, as insulin dosing relies on accurate glucose data.

Choice C reason: Reducing the insulin dose by 2 units corrects the error, aligning with the sliding scale for the recorded glucose level. Excess insulin can cause hypoglycemia, affecting brain and organ function. This action ensures safe administration, preventing potentially severe metabolic consequences.

Choice D reason: Recording the discrepancy does not correct the dosing error and risks administering an unsafe dose. Documentation is secondary to ensuring the correct insulin amount is given, as 2 extra units could lead to hypoglycemia, requiring immediate correction, not just notation.