A nurse is caring for a client who has chronic liver disease. Which of the following medications should the nurse recognize as appropriate for this client?

A. The nurse monitors the client for over sedation. Monitoring for over sedation is an essential nursing responsibility when caring for a client using a patient-controlled analgesia (PCA) device. Opioid medications used in PCAs can cause respiratory depression, drowsiness, and decreased level of consciousness, so frequent assessments are necessary to ensure client safety.

B. The nurse reassures the client that the PCA device will not cause an overdose. PCA devices are programmed to deliver a controlled dose of medication at set intervals, reducing the risk of overdose. Educating the client about this built-in safety feature helps alleviate anxiety and encourages appropriate pain management. However, the nurse should also instruct the client to report symptoms of over sedation or inadequate pain relief.

C. The nurse asks the client to demonstrate dose delivery. Encouraging the client to demonstrate how to use the PCA device ensures they understand how to properly self-administer medication. This reinforces client education, promotes effective pain management, and minimizes unnecessary delays in pain relief due to improper use.

D. The nurse administers a PCA dose for the client. Only the client should press the PCA button to self-administer medication. This prevents accidental overdose or over sedation that could occur if the client is too sedated to recognize their own need for pain relief. If the client is unable to use the PCA properly, alternative pain management strategies should be considered, rather than allowing a nurse or family member to press the button.

A. Premedicate the client with diphenhydramine. Premedicating with diphenhydramine is not necessary unless the client has a history of mild allergic reactions to erythromycin. Erythromycin is a macrolide antibiotic and does not have significant cross-reactivity with penicillin, making premedication unnecessary.

B. Request a different route of administration from the provider. Changing the route of administration does not address concerns about allergy. Erythromycin is well tolerated in clients with a penicillin allergy, and there is no indication that a different route would be required unless the client has difficulty swallowing or gastrointestinal intolerance.

C. Administer the medication to the client. Erythromycin belongs to the macrolide class and is commonly prescribed as an alternative for clients allergic to penicillin. There is no cross-reactivity between macrolides and penicillins, making erythromycin a safe and effective option for treating bacterial infections in these clients.

D. Request a different medication from the provider. There is no need to request an alternative medication unless the client has a known allergy to erythromycin. Since macrolides are safe for clients with penicillin allergies, withholding the medication without a valid reason could delay necessary treatment.