A nurse is preparing to administer the initial dose of penicillin G IM to a client. The nurse should monitor for which of the following as an indication of an allergic reaction following the injection?

A. "Decrease your daily sodium intake."
Incorrect Explanation: This instruction is appropriate for a client taking lithium carbonate.
Explanation: Lithium is a mood-stabilizing medication commonly prescribed for conditions like bipolar disorder. High levels of sodium can lead to increased lithium retention in the body, potentially raising the risk of toxicity. Advising the client to decrease their daily sodium intake helps prevent this.
B. "Take this medication 2 hours before a meal."
Incorrect Explanation: This instruction is not accurate for lithium carbonate.
Explanation: Lithium carbonate is typically taken with food or milk to help minimize stomach upset. Taking it on an empty stomach might increase the risk of gastrointestinal side effects.
C. "Limit foods containing tyramine."
Incorrect Explanation: This instruction is not directly relevant to lithium carbonate.
Explanation: Tyramine is a compound found in some foods and can interact with certain medications like monoamine oxidase inhibitors (MAOIs), but it is not a primary concern with lithium carbonate.
D. "Report swelling of the feet to your provider."
Correct Explanation: This instruction is appropriate for a client taking lithium carbonate.
Explanation: Lithium can lead to water retention, which might result in swelling, particularly in the feet and ankles. Reporting swelling is important as it can be an early sign of potential side effects or changes in kidney function.

A. Increased blood pressure:
An elevated aPTT (activated partial thromboplastin time) suggests that the client is receiving heparin therapy. Heparin is an anticoagulant that prevents blood clotting. It's not likely to cause a significant increase in blood pressure directly. Changes in blood pressure may occur due to other factors, but they are not directly related to heparin therapy.
B. Decreased temperature:
Heparin administration does not typically have a direct effect on body temperature. Changes in body temperature might be due to other factors such as infection, but they are not a primary consideration when assessing the effects of heparin therapy.
C. Decreased respiratory rate:
Heparin administration is not known to directly affect respiratory rate. Changes in respiratory rate could be related to respiratory conditions, pain, or other factors unrelated to heparin therapy.
D. Increased pulse rate:
This is the correct choice. Heparin is known to affect the clotting process by inhibiting clot formation. An extended aPTT of 90 seconds indicates that the client's blood is taking longer to form clots than the normal range. This could lead to concerns about potential bleeding complications. Increased pulse rate could be an early sign of bleeding or decreased perfusion, as the body may attempt to compensate for reduced blood volume due to prolonged clotting times.