A nurse is caring for a client who has ulcerative colitis and is receiving sulfasalazine. Which of the following findings requires immediate intervention?

A. The nurse monitors the client for over sedation. Monitoring for over sedation is an essential nursing responsibility when caring for a client using a patient-controlled analgesia (PCA) device. Opioid medications used in PCAs can cause respiratory depression, drowsiness, and decreased level of consciousness, so frequent assessments are necessary to ensure client safety.

B. The nurse reassures the client that the PCA device will not cause an overdose. PCA devices are programmed to deliver a controlled dose of medication at set intervals, reducing the risk of overdose. Educating the client about this built-in safety feature helps alleviate anxiety and encourages appropriate pain management. However, the nurse should also instruct the client to report symptoms of over sedation or inadequate pain relief.

C. The nurse asks the client to demonstrate dose delivery. Encouraging the client to demonstrate how to use the PCA device ensures they understand how to properly self-administer medication. This reinforces client education, promotes effective pain management, and minimizes unnecessary delays in pain relief due to improper use.

D. The nurse administers a PCA dose for the client. Only the client should press the PCA button to self-administer medication. This prevents accidental overdose or over sedation that could occur if the client is too sedated to recognize their own need for pain relief. If the client is unable to use the PCA properly, alternative pain management strategies should be considered, rather than allowing a nurse or family member to press the button.

A. Bleeding. Cefotetan, a second-generation cephalosporin, can interfere with vitamin K metabolism, leading to a decreased ability to form blood clots. When combined with NSAIDs, which have an antiplatelet effect, the risk of bleeding increases. Clients taking both medications should be monitored for bruising, prolonged bleeding, or signs of gastrointestinal hemorrhage such as black, tarry stools.

B. Dysrhythmias. Cefotetan and NSAIDs do not have significant cardiac effects that would lead to dysrhythmias. Some antibiotics, such as macrolides and fluoroquinolones, can cause QT prolongation, but cefotetan does not affect cardiac conduction.

C. Dizziness. While NSAIDs can sometimes cause dizziness as a side effect, this is not a significant interaction between cefotetan and NSAIDs. Cefotetan does not commonly cause dizziness unless associated with an allergic reaction or severe hypotension due to an adverse effect.

D. Jaundice. Cefotetan is metabolized by the liver, but it is not highly hepatotoxic and does not commonly cause jaundice. NSAIDs, when used long-term or in high doses, may contribute to liver dysfunction, but this is not a primary concern in the interaction between these two medications.