During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first?

Choice A reason: Quinolones, like ciprofloxacin, inhibit bacterial DNA gyrase and have no structural similarity to penicillin. They are safe in penicillin-allergic patients, as there is no cross-reactivity. Their side effects, like tendonitis, are unrelated to penicillin’s beta-lactam ring, making this class safe.

Choice B reason: Sulfonamides, like trimethoprim-sulfamethoxazole, inhibit bacterial folate synthesis and are not structurally related to penicillin. They do not cause cross-reactivity in penicillin-allergic patients. Their hypersensitivity reactions are distinct, making them a safe alternative for patients with penicillin allergies.

Choice C reason: Cephalosporins share a beta-lactam ring with penicillins, leading to a 5-10% cross-reactivity risk in penicillin-allergic patients. Allergic reactions, like anaphylaxis, may occur, so the nurse should question cephalosporin orders, especially for first-generation agents, to ensure patient safety.

Choice D reason: Tetracyclines, like doxycycline, inhibit protein synthesis and have no structural similarity to penicillin’s beta-lactam ring. They are safe in penicillin-allergic patients, with no cross-reactivity risk. Their side effects, like photosensitivity, are unrelated to penicillin allergies, making this class safe.

Choice A reason: Holding albuterol treatment for 24 hours is inappropriate, as jitteriness is a common side effect of beta-2 agonists due to sympathetic stimulation. Albuterol’s benefits in relieving bronchospasm outweigh transient side effects. Discontinuing therapy could worsen asthma symptoms, and monitoring is preferred over stopping treatment.

Choice B reason: Jitteriness is an expected side effect of albuterol, a beta-2 agonist, due to its stimulation of beta-adrenergic receptors, increasing cyclic AMP and causing mild tremors or nervousness. Checking the pulse ensures no serious tachycardia, allowing the nurse to monitor and reassure the patient while continuing necessary therapy.

Choice C reason: Notifying the physician is unnecessary for jitteriness, a common and expected side effect of albuterol. It results from beta-2 receptor stimulation, not a severe adverse reaction. Monitoring vital signs, like pulse, is sufficient to assess the patient’s response without escalating to physician notification immediately.

Choice D reason: Skipping the next albuterol treatment is not warranted, as jitteriness is a transient, expected side effect due to sympathetic stimulation. Albuterol is critical for asthma management, and discontinuation could exacerbate symptoms. Monitoring and patient education about expected effects are more appropriate than altering the treatment schedule.