A nurse is collecting data from an older adult client who is receiving ondansetron IV, has a history of diabetes mellitus and cardiac myopathy, and is receiving chemotherapy to treat cancer. For which of the following adverse effects of ondansetron should the nurse monitor? (Select all that apply)

D. The nurse should promptly notify the healthcare provider to discuss the allergy history and request an alternative antibiotic that is not structurally related to penicillin or cephalosporins. Examples of alternative antibiotics may include antibiotics from different classes such as macrolides or fluoroquinolones, depending on the indication and sensitivity profile.

A. Diphenhydramine (Benadryl) is an antihistamine that can help manage allergic reactions. However, it should not be used as a standalone precautionary measure for a client with a history of anaphylaxis to penicillin. Anaphylaxis is a severe allergic reaction that can lead to life-threatening symptoms such as difficulty breathing, swelling, and low blood pressure.

B. Before taking any further steps, the nurse should clarify and confirm the nature and severity of the client's allergic reaction to penicillin. Anaphylaxis is a serious allergic reaction characterized by rapid onset and potentially life-threatening symptoms. Clarifying the history ensures accurate decision- making regarding the administration of cephalexin.

C. This is not recommended without further clarification and assessment. Given the history of anaphylaxis to penicillin, there is a significant risk of cross-reactivity with cephalosporins like cephalexin. Cephalosporins have a structural similarity to penicillin and can provoke allergic reactions in individuals with penicillin allergy, including anaphylaxis.

D. Muscle weakness is a hallmark sign of hypokalemia. Potassium is crucial for proper muscle contraction, and low levels can impair muscle function. This weakness can affect skeletal muscles (resulting in fatigue, cramps, or generalized weakness) as well as smooth muscles (contributing to constipation or other gastrointestinal symptoms).

A. Hypokalemia is not typically associated with hyperactive bowel sounds.

B. Cerebral edema is not typically associated with hypokalemia. Instead, cerebral edema can occur with conditions such as hyponatremia (low sodium levels) or other metabolic disturbances.

C. Hypokalemia is more commonly associated with hypotension (low blood pressure) rather than hypertension. Low potassium levels can affect vascular smooth muscle tone, potentially leading to vasodilation and hypotension.