A nurse is reviewing a client's peak and trough levels of gentamicin. The peak should be 6 to 8 mcg/mL and the trough should be 0.5 to 1 mcg/mL. The client's peak is10 mcg/mL and his trough is 2.3 mcg/mL. Which of the following clinical manifestations should the nurse expect with these findings? (Select all that apply.)

A. A 5 mL syringe can hold up to 5 mL of fluid. It is suitable for administering 2 mL of medication, as it provides enough capacity with some additional space to ensure accurate measurement and prevent overfilling.

B. A 1 mL syringe is too small for administering a 2 mL injection. It would not accommodate the entire volume, and attempting to draw and administer 2 mL with a 1 mL syringe could result in spillage or inaccurate dosing.

C. A 10 mL syringe is larger than necessary for administering a 2 mL injection. While it can hold the required volume and more, it is bulkier and might be less convenient for administering smaller volumes like 2 mL.

D. A 3 mL syringe can also accommodate a 2 mL injection. However, a 5 mL syringe would provide a more appropriate capacity with a bit of extra space, which can be beneficial for accurate measurement and ease of administration.

D. The nurse should promptly notify the healthcare provider to discuss the allergy history and request an alternative antibiotic that is not structurally related to penicillin or cephalosporins. Examples of alternative antibiotics may include antibiotics from different classes such as macrolides or fluoroquinolones, depending on the indication and sensitivity profile.

A. Diphenhydramine (Benadryl) is an antihistamine that can help manage allergic reactions. However, it should not be used as a standalone precautionary measure for a client with a history of anaphylaxis to penicillin. Anaphylaxis is a severe allergic reaction that can lead to life-threatening symptoms such as difficulty breathing, swelling, and low blood pressure.

B. Before taking any further steps, the nurse should clarify and confirm the nature and severity of the client's allergic reaction to penicillin. Anaphylaxis is a serious allergic reaction characterized by rapid onset and potentially life-threatening symptoms. Clarifying the history ensures accurate decision- making regarding the administration of cephalexin.

C. This is not recommended without further clarification and assessment. Given the history of anaphylaxis to penicillin, there is a significant risk of cross-reactivity with cephalosporins like cephalexin. Cephalosporins have a structural similarity to penicillin and can provoke allergic reactions in individuals with penicillin allergy, including anaphylaxis.