The practical nurse (PN) is administering the 0900 medications to a client who was admitted during the night. Which client statement indicates that the PN should further assess the prescription?

Choice A reason: Peak and trough levels are relevant for drugs like antibiotics, not meloxicam, a nonsteroidal anti-inflammatory drug (NSAID). Meloxicam’s efficacy is assessed clinically, not via blood levels, as it reduces inflammation and pain, making this choice irrelevant for costochondritis management.

Choice B reason: Reassessing pain 30 minutes after meloxicam administration evaluates its effectiveness, as this NSAID inhibits cyclooxygenase, reducing prostaglandin-mediated inflammation and pain in costochondritis. Timely reassessment ensures adequate pain relief, guiding further interventions for breathing discomfort, making this the appropriate intervention.

Choice C reason: Involuntary lip and tongue movements are associated with antipsychotics, not meloxicam. This NSAID does not cause neurological side effects like tardive dyskinesia. Monitoring for this is irrelevant, as meloxicam’s primary concerns are gastrointestinal or renal, not movement disorders.

Choice D reason: Strict intake and output monitoring is unnecessary for meloxicam, which primarily affects inflammation, not fluid balance. While long-term use may impact kidneys, pain reassessment is more immediate for costochondritis, making this choice less relevant than evaluating therapeutic pain relief.

Choice A reason: Cephalexin, a cephalosporin, has a 5–10% cross-reactivity risk with penicillin allergies due to similar beta-lactam structures. An anaphylactic history increases the risk of severe reactions. Contacting the provider ensures safety, potentially leading to an alternative antibiotic to prevent life-threatening allergic responses.

Choice B reason: Monitoring for rash or hives is reactive and insufficient for a client with a penicillin anaphylaxis history. Cephalexin’s cross-reactivity risk requires proactive avoidance, not just observation, as anaphylaxis can occur rapidly, making this choice inadequate compared to provider consultation.

Choice C reason: Giving cephalexin with an antihistamine does not prevent anaphylaxis, which can be rapid and severe in penicillin-allergic clients. Antihistamines mitigate mild allergies but are ineffective against severe reactions. This choice is unsafe without confirming the drug’s appropriateness first.

Choice D reason: Administering cephalexin as prescribed ignores the significant risk of cross-reactivity with penicillin, given the client’s anaphylactic history. This could trigger a life-threatening reaction, as cephalosporins share structural similarities with penicillins, making immediate administration without verification dangerous.