A patient is prescribed Flexeril (cyclobenzaprine) for muscle spasms. Which of the following is the most common side effect that the nurse should educate the patient about?

Choice A reason: Allergy is an immune mediated reaction to a substance that causes symptoms such as rash, itching, swelling, or anaphylaxis. It is not related to the duration or effectiveness of the medication. The patient does not report any signs of allergy to the opioids.

Choice B reason: Addiction is a chronic and compulsive disorder that involves seeking and using a substance despite harmful consequences. It is characterized by loss of control, craving, and impaired functioning. The patient does not show any signs of addiction to the opioids, such as increasing the dose, obtaining the medication illegally, or neglecting other responsibilities.

Choice C reason: Withdrawal is a syndrome that occurs when a substance is abruptly discontinued or reduced after prolonged use. It causes physical and psychological symptoms such as anxiety, agitation, sweating, nausea, or tremors. The patient does not experience any signs of withdrawal from the opioids, as they are still taking the medication as prescribed.

Choice D reason: Tolerance is a phenomenon that occurs when a substance loses its effectiveness over time due to repeated exposure. It requires higher doses or more frequent administration to achieve the same effect. The patient reports a sign of tolerance to the opioids, as they feel that the medication does not work as well anymore. The nurse should assess the patient's pain level, monitor the opioid dose, and consult with the prescriber about possible adjustments or alternatives.

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..