A nurse is preparing to administer the initial dose of penicillin G IM to a client. The nurse should monitor for which of the following as an indication of an allergic reaction following the injection?

A. "Rinse your child's mouth following administration." - This is important advice to prevent the development of oral thrush (a fungal infection) and to reduce the risk of irritation in the mouth and throat caused by the medication. After using a fluticasone inhaler, rinsing the mouth with water can help prevent these side effects.

C. "Shake the device prior to administration." - Shaking the inhaler before use ensures proper mixing of the medication and enhances its effectiveness.

D. "A spacer will make it easier to use the device." - A spacer is a device that attaches to the inhaler and helps the medication get into the lungs more effectively, especially for children who might have difficulty coordinating the timing of inhalation with activating the inhaler.

The other options:

B. "Have your child take one inhalation as needed for shortness of breath." - This instruction might not be accurate, as fluticasone is usually used as a maintenance medication to control chronic conditions like asthma. It's not typically used as a rescue inhaler for immediate shortness of breath.

E. "Soak the inhaler in water after use." - Soaking the inhaler in water after use is not a standard practice and is not necessary for proper administration or maintenance.

A. Estrogen-progestin combination:
Correct Answer: This medication interacts with carbamazepine.
Explanation: Carbamazepine is known to induce certain liver enzymes, including cytochrome P450 enzymes. These enzymes play a role in the metabolism of various medications, including estrogen-containing oral contraceptives (estrogen-progestin combinations). Carbamazepine can increase the metabolism of estrogen-progestin combinations, potentially reducing their effectiveness and increasing the risk of contraceptive failure. Therefore, this interaction can lead to decreased contraceptive efficacy and the potential for unintended pregnancy.
B. Nicotine transdermal system:
Incorrect Explanation: This medication does not interact with carbamazepine.
Explanation: Nicotine replacement therapies, such as nicotine transdermal systems, are not known to have significant interactions with carbamazepine. These therapies are primarily used to aid in smoking cessation and do not share metabolic pathways with carbamazepine.
C. Diphenhydramine:
Incorrect Explanation: This medication does not interact with carbamazepine.
Explanation: Diphenhydramine is an antihistamine used for allergies and as a sleep aid. It does not have a well-established interaction with carbamazepine. However, it's important to note that carbamazepine can have central nervous system (CNS) effects, so caution should be exercised when combining it with other medications that also have CNS effects.
D. Beclomethasone:
Incorrect Explanation: This medication does not interact with carbamazepine.
Explanation: Beclomethasone is a corticosteroid used to manage inflammation associated with conditions like asthma and allergic rhinitis. It is not known to interact with carbamazepine. These two medications have different mechanisms of action and do not share significant metabolic pathways.