A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in the client’s plan of care?

Choice A Reason:

Contact the healthcare provider: Given the client’s history of anaphylactic reaction to penicillin, there is a potential risk of cross-reactivity with cephalexin, a cephalosporin. Although the risk of cross-reactivity is relatively low, it is still significant enough to warrant caution. Studies indicate that 1-4% of people with a true penicillin allergy may also react to cephalosporins. Therefore, the nurse should contact the healthcare provider to discuss alternative antibiotics or additional precautions.

Choice B Reason:

Give with prescribed antihistamine: While antihistamines can help manage mild allergic reactions, they are not sufficient to prevent or treat anaphylaxis. Anaphylactic reactions require immediate medical intervention, including epinephrine administration. Therefore, relying solely on antihistamines is not an appropriate or safe action in this scenario.

Choice C Reason:

Administer the medication as prescribed: Administering cephalexin without consulting the healthcare provider could put the client at risk of a severe allergic reaction. Given the client’s history of anaphylaxis to penicillin, it is crucial to verify the safety of cephalexin with the healthcare provider before administration.

Choice D Reason:

Monitor the client for a rash or hives: While monitoring for allergic reactions is essential, it should not be the primary action in this case. The priority is to prevent a potential severe allergic reaction by consulting the healthcare provider before administering the medication. Monitoring alone does not address the underlying risk of cross-reactivity.

Choice A reason:

A CT scan performed six months earlier does not typically require follow-up unless there were specific findings or complications from the previous scan. The timing of the previous scan is not a contraindication for a new CT scan with contrast. However, it is always good practice to review previous imaging results to compare and assess any changes.

Choice B reason:

Metformin hydrochloride is a medication used to manage type 2 diabetes mellitus. It is important to follow up on this information because metformin can interact with the contrast dye used in CT scans. The combination can increase the risk of lactic acidosis, a rare but serious complication. Therefore, it is crucial to assess kidney function and possibly withhold metformin before and after the procedure to reduce this risk.

Choice C reason:

A report of the client’s sobriety for the last five years is generally a positive aspect of their medical history and does not require follow-up in the context of a CT scan with contrast. Sobriety does not impact the safety or efficacy of the contrast dye used in the scan.

Choice D reason:

A metal hip prosthesis placed twenty years ago is relevant information but does not typically require follow-up before a CT scan. Unlike MRI, where metal implants can cause issues, CT scans are generally safe for patients with metal prostheses. However, the presence of metal can sometimes affect the quality of the images, so it is important for the radiologist to be aware of it.