A patient receiving Morphine for postoperative pain relief displays slow, shallow breathing with a rate of 8 breaths/minute. The nurse recognizes this as a side effect called:

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: This is correct. Nausea, vomiting, and diarrhea are the most common side effects of metformin, especially when the drug is started or the dose is increased. These side effects occur because metformin can interfere with the absorption of glucose and other nutrients in the intestines, causing osmotic diarrhea. The nurse should advise the client to take metformin with food, start with a low dose and gradually increase it, and drink plenty of fluids to prevent dehydration. The nurse should also monitor the client for signs of lactic acidosis, a rare but serious complication of metformin that causes severe diarrhea, abdominal pain, muscle cramps, and difficulty breathing.

Choice B reason: This is incorrect. Palpitations are not a common side effect of metformin. Palpitations are the sensation of a rapid, irregular, or pounding heartbeat, which can be caused by various factors, such as stress, anxiety, caffeine, nicotine, or heart problems. Metformin does not affect the heart rate or rhythm directly, but it can lower the blood sugar levels, which can trigger the release of adrenaline, a hormone that can cause palpitations. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, avoid alcohol and caffeine, and report any chest pain or shortness of breath.

Choice C reason: This is incorrect. Headaches are not a common side effect of metformin. Headaches are the pain or discomfort in the head, scalp, or neck, which can be caused by various factors, such as stress, dehydration, or sinus infection. Metformin does not cause headaches directly, but it can lower the blood sugar levels, which can cause headaches as a symptom of hypoglycemia. The nurse should check the client's blood sugar levels and advise the client to eat regular meals and snacks, drink plenty of water, and take painkillers as needed.

Choice D reason: This is incorrect. Heartburn is not a common side effect of metformin. Heartburn is the burning sensation in the chest or throat, which is caused by the reflux of stomach acid into the esophagus. Metformin does not cause heartburn directly, but it can worsen it if the client already has gastroesophageal reflux disease (GERD), a condition where the lower esophageal sphincter is weak or relaxed and allows the acid to flow back. The nurse should advise the client to take metformin with food, avoid spicy or fatty foods, elevate the head of the bed, and take antacids as needed.