The nurse is caring for a client who is taking metformin (Glucophage) for hyperglycemia prior to admission. The nurse would question the following order for this client:

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..

Choice A reason: Tinnitus is a rare side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Tinnitus is a ringing or buzzing sound in the ears that can be caused by various factors, such as ear infections, noise exposure, or certain medications. Flexeril does not affect the auditory system directly, but it can cause confusion or dizziness, which may worsen the perception of tinnitus.

Choice B reason: Drowsiness is the most common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Drowsiness occurs because Flexeril has sedative and anticholinergic properties, which means that it blocks the action of acetylcholine, a neurotransmitter that regulates arousal and alertness. Flexeril can impair the mental and physical abilities, especially in elderly patients or those who take other medications that cause drowsiness¹. The nurse should educate the patient about the risk of drowsiness and advise them to avoid driving or operating machinery while taking Flexeril.

Choice C reason: Diarrhea is not a common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Diarrhea is a condition that causes loose or watery stools, which can be caused by various factors, such as infections, food intolerance, or certain medications. Flexeril does not affect the gastrointestinal system directly, but it can cause dry mouth, nausea, or constipation, which may alter the bowel movements¹.

Choice D reason: Palpitations are not a common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Palpitations are a sensation of rapid or irregular heartbeat, which can be caused by various factors, such as stress, anxiety, caffeine, or certain medications. Flexeril does not affect the cardiac system directly, but it can lower the blood pressure or interact with other medications that affect the heart rate, such as betablockers or antidepressants¹.