A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions?

Choice A reason: Serum potassium level of 5.5 mEq/L is above the normal range of 3.55.0 mEq/L, but it is not a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can also cause the loss of potassium in the urine, which can lead to hypokalemia, a condition that causes muscle weakness, cramps, arrhythmias, or cardiac arrest. The nurse should monitor the serum potassium level and administer potassium supplements or potassium sparing diuretics as prescribed to prevent hypokalemia.

Choice B reason: Blood pressure of 130/80 mmHg is slightly above the normal range of 120/80 mmHg, but it is not a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can reduce the fluid volume and the peripheral resistance, which can lower the blood pressure and prevent or treat hypertension, edema, or heart failure. The nurse should monitor the blood pressure regularly and adjust the dose of Lasix as prescribed to maintain a normal blood pressure.

Choice C reason: Serum potassium level of 3.0 mEq/L is below the normal range of 3.55.0 mEq/L, and it is a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can also cause the loss of potassium in the urine, which can lead to hypokalemia, a condition that causes muscle weakness, cramps, arrhythmias, or cardiac arrest. The nurse should notify the health care provider immediately and prepare to administer interventions such as potassium supplements or potassium sparing diuretics to correct hypokalemia.

Choice D reason: Serum sodium level of 140 mEq/L is within the normal range of 135145 mEq/L, and it is not a concern for the client taking Lasix, which is a medication that increases the urine output and lowers the blood pressure by inhibiting the reabsorption of sodium and water in the kidney. Lasix can cause the loss of sodium in the urine, which can lead to hyponatremia, a condition that causes confusion, seizures, coma, or death. The nurse should monitor the serum sodium level and administer sodium supplements or fluids as prescribed to prevent hyponatremia.

Choice A reason: This is incorrect. A recent history of diarrhea for 3 days is not a contraindication for receiving a cephalosporin antibiotic. However, the nurse should monitor the client for signs of dehydration and electrolyte imbalance, and advise the client to drink plenty of fluids and avoid caffeine and alcohol. The nurse should also be aware that cephalosporins can cause or worsen diarrhea in some people, especially if they disrupt the normal flora of the gut. In rare cases, cephalosporins can cause a serious infection called Clostridioides difficile (C. difficile) colitis, which is characterized by severe diarrhea, abdominal pain, fever, and blood or pus in the stool. The nurse should instruct the client to report any of these symptoms and to avoid taking antidiarrheal drugs without consulting the doctor.

Choice B reason: This is incorrect. Serum creatinine 0.8 mg/dL is not a contraindication for receiving a cephalosporin antibiotic. Serum creatinine is a measure of kidney function, and a normal range for adults is 0.6 to 1.2 mg/dL. A high serum creatinine level may indicate kidney damage or impairment, which can affect the clearance of cephalosporins and increase the risk of toxicity. Therefore, the dose of cephalosporins may need to be adjusted in people with kidney problems, except for ceftriaxone and cefoperazone, which are excreted mainly through the bile. The nurse should check the client's renal function tests and the doctor's orders before administering a cephalosporin antibiotic.

Choice C reason: This is incorrect. A history of phlebitis following an IV infusion of 0.9% sodium chloride with 10 mEq of potassium chloride is not a contraindication for receiving a cephalosporin antibiotic. Phlebitis is the inflammation of a vein, which can be caused by mechanical, chemical, or infectious factors. Some IV solutions, such as potassium chloride, can irritate the vein and cause phlebitis. However, this does not mean that the client is allergic or intolerant to cephalosporins, which are usually well tolerated by the veins. The nurse should assess the client's IV site for signs of phlebitis, such as redness, swelling, pain, or warmth, and change the site if needed. The nurse should also dilute the cephalosporin antibiotic according to the manufacturer's instructions and administer it slowly over the recommended time to minimize the risk of phlebitis.

Choice D reason: This is correct. A severe allergy to penicillins is a contraindication for receiving a cephalosporin antibiotic. Penicillins and cephalosporins belong to the same class of beta lactam antibiotics, which share a similar chemical structure. Therefore, people who are allergic to penicillins have a higher chance of being allergic to cephalosporins, especially the first and secondgeneration ones. An allergic reaction to cephalosporins can range from mild skin rashes to life-threatening anaphylaxis, which is a severe hypersensitivity reaction that causes difficulty breathing, low blood pressure, and shock. The nurse should ask the client about their allergy history and the type and severity of their reactions. The nurse should report any history of penicillin allergy to the doctor and avoid giving cephalosporins to the client unless the doctor confirms that it is safe to do so..