When educating a patient about Lorazepam (Ativan), the nurse should advise against the concurrent use of which substance?

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: Monoamine oxidase inhibitors (MAOIs) are not the correct class of medications to which escitalopram (Lexapro) belongs. MAOIs are a group of antidepressants that work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine, and dopamine. MAOIs can increase the levels of these neurotransmitters in the brain and improve mood and energy. However, MAOIs can also cause serious side effects and interactions with other drugs and foods, and they are not commonly used as firstline treatment for depression. Escitalopram is not an MAOI, and it should not be taken with MAOIs or within 14 days of stopping or starting MAOIs, as this can cause a dangerous drug interaction called serotonin syndrome.

Choice B reason: Betablockers are not the correct class of medications to which escitalopram (Lexapro) belongs. Betablockers are a group of drugs that work by blocking the beta receptors on the heart and blood vessels, which are stimulated by adrenaline and noradrenaline. Betablockers can lower the heart rate, blood pressure, and cardiac output, and they are used to treat conditions such as hypertension, angina, arrhythmias, and heart failure. Betablockers can also reduce anxiety and tremors, but they are not antidepressants and they do not affect serotonin levels. Escitalopram is not a betablocker, and it does not have any significant effect on the cardiovascular system.

Choice C reason: Benzodiazepines are not the correct class of medications to which escitalopram (Lexapro) belongs. Benzodiazepines are a group of drugs that work by enhancing the activity of the neurotransmitter gammaaminobutyric acid (GABA), which has a calming and sedating effect on the brain. Benzodiazepines are used to treat anxiety, insomnia, seizures, and muscle spasms, and they can also cause relaxation, drowsiness, and amnesia. Benzodiazepines are not antidepressants and they do not affect serotonin levels. Escitalopram is not a benzodiazepine, and it does not have any significant effect on GABA receptors .

Choice D reason: Selective serotonin reuptake inhibitors (SSRIs) are the correct class of medications to which escitalopram (Lexapro) belongs. SSRIs are a group of antidepressants that work by blocking the reuptake of serotonin by the nerve cells, which increases the availability of serotonin in the synaptic cleft. Serotonin is a neurotransmitter that regulates mood, appetite, sleep, and cognition, and low levels of serotonin are associated with depression and anxiety. SSRIs can improve the symptoms of depression and anxiety by enhancing the serotonin signaling in the brain. Escitalopram is an SSRI, and it is used to treat major depressive disorder and generalized anxiety disorder.