A patient calls the clinic and reports feeling unwell, with symptoms of rapid heart rate, severe headache, and light-headedness. The nurse notes that the patient was prescribed metronidazole a few days ago.

What substance could likely be causing these symptoms?

Choice A rationale
Lactulose is used to treat hepatic encephalopathy, a condition that affects patients with liver failure. It works by reducing the absorption of ammonia in the gut. Having loose, watery stools is a desired therapeutic effect of lactulose. Therefore, no action is required if the patient is oriented and has had 6 loose, watery stools since 07007.
Choice B rationale
Withholding the dose and contacting the doctor for daily stool count parameters is not necessary in this situation. The patient is currently oriented, which suggests that the lactulose is effectively managing their hepatic encephalopathy.
Choice C rationale
Administering the medication because diarrhea is a common side effect is not the correct course of action. The presence of loose, watery stools is not merely a side effect, but a desired therapeutic effect of lactulose in the treatment of hepatic encephalopathy.
Choice D rationale
Removing fall precautions due to changes in mental status is not necessary in this situation. The patient is currently oriented, which suggests that the lactulose is effectively managing their hepatic encephalopathy.

Choice A rationale
Amoxicillin is a type of penicillin, and if a client has had a rash or any other allergic reaction to penicillin in the past, it’s possible they could have a similar reaction to amoxicillin. Therefore, the nurse should discuss with the provider the possibility of using a different antibiotic. This is important because allergic reactions to antibiotics can be severe and even life-threatening.
Choice B rationale
Administering the amoxicillin and keeping epinephrine on hand is not the best course of action. While epinephrine can be used to treat severe allergic reactions, it’s better to avoid the risk of an allergic reaction in the first place if possible.
Choice C rationale
Requesting the provider to prescribe an antihistamine would not address the potential for a serious allergic reaction to the amoxicillin. Antihistamines can help with mild allergic reactions, but they may not be sufficient for a severe reaction.
Choice D rationale
Asking for an order for a beta-lactamase resistant drug might not be necessary. Beta-lactamase resistant drugs are used to treat infections caused by bacteria that produce beta-lactamase, an enzyme that can break down and resist penicillins. However, the client’s allergy to penicillin does not necessarily mean that a beta-lactamase resistant drug is required.