A client receives a prescription for golimumab for psoriasis. Which information should the practical nurse (PN) obtain prior to administration?

Choice A reason: Cephalexin, a cephalosporin, has a 5–10% cross-reactivity risk with penicillin allergies due to similar beta-lactam structures. An anaphylactic history increases the risk of severe reactions. Contacting the provider ensures safety, potentially leading to an alternative antibiotic to prevent life-threatening allergic responses.

Choice B reason: Monitoring for rash or hives is reactive and insufficient for a client with a penicillin anaphylaxis history. Cephalexin’s cross-reactivity risk requires proactive avoidance, not just observation, as anaphylaxis can occur rapidly, making this choice inadequate compared to provider consultation.

Choice C reason: Giving cephalexin with an antihistamine does not prevent anaphylaxis, which can be rapid and severe in penicillin-allergic clients. Antihistamines mitigate mild allergies but are ineffective against severe reactions. This choice is unsafe without confirming the drug’s appropriateness first.

Choice D reason: Administering cephalexin as prescribed ignores the significant risk of cross-reactivity with penicillin, given the client’s anaphylactic history. This could trigger a life-threatening reaction, as cephalosporins share structural similarities with penicillins, making immediate administration without verification dangerous.

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.