# A 40-year-old client with community-acquired pneumonia is being discharged on azithromycin Z-Pak (500 mg PO day 1, then 250 mg daily on days 2 to 5). Which client teaching is most important? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375232&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 40-year-old client with community-acquired pneumonia is being discharged on azithromycin Z-Pak (500 mg PO day 1, then 250 mg daily on days 2 to 5). Which client teaching is most important? ## Option 1. Take all 5 doses on schedule even after symptoms improve, take with or without food (with food if GI upset), avoid combining with QT-prolonging drugs, report palpitations, fainting, severe diarrhea, or yellowing of skin/eyes; antacids reduce absorption — separate by 2 hours. **✔ Correct answer** 2. You may discontinue the medication once your fever has resolved and your cough becomes non-productive, because azithromycin continues to work in the lungs for several days after the last dose taken; if symptoms return, restart the remaining pills and finish the course. 3. To ensure the full benefit, take azithromycin with grapefruit juice to enhance absorption; avoid lying down for at least 30 minutes after each dose to prevent esophageal irritation; contact your provider if you develop a rash or difficulty breathing. 4. To avoid stomach upset, you can take the medication every other day instead of daily; this schedule is acceptable because azithromycin has a long duration of action; if you experience diarrhea, stop taking the drug until it resolves and then resume the next scheduled dose. **Correct answer: 1** ## Explanation Azithromycin (Zithromax, Z-Pak) is a macrolide antibiotic with a long half-life that allows a 5-day course (or single 1 g dose for chlamydia, etc.). It is widely used for community-acquired pneumonia, atypical pneumonia, pertussis, sinusitis, otitis media in penicillin-allergic patients, and STIs. Key teaching: (1) complete the course on schedule even after symptom improvement to prevent treatment failure and resistance; (2) take with or without food — taking with food reduces nausea but slightly decreases absorption; the immediate-release form is flexible; (3) common GI side effects — nausea, vomiting, abdominal pain, diarrhea; report severe or bloody diarrhea (C. difficile); (4) QT prolongation is a class warning for macrolides; report palpitations, syncope, or known electrolyte abnormalities; avoid combining with other QT-prolonging drugs without prescriber review; (5) hepatotoxicity is rare but possible — report jaundice, dark urine, RUQ pain; (6) aluminum or magnesium antacids reduce absorption — separate by 2 hours; (7) hearing loss reported with prolonged or high doses; (8) compared with erythromycin and clarithromycin, azithromycin is a weaker CYP3A4 inhibitor but still has interaction potential; review concurrent meds. Stopping at 2 days, grapefruit juice, and skipping doses are unsafe. ## In-depth explanation Complete the 5-day Z-Pak; antacid spacing 2 hours; QT and CDiff awareness. Azithromycin has the lowest CYP3A4 inhibition of macrolides but is not interaction-free. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en) - [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375232&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375232&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375232&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375232&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375232&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. 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