The nurse is caring for a client diagnosed with beta lactam resistant bacteria. The nurse anticipates administering which broad spectrum antibiotic?

Choice A reason: "If my breathing begins to feel tight, I will use the cromolyn immediately." is an incorrect statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. Cromolyn is a medication that prevents the release of inflammatory substances from the mast cells in the airways, which can cause bronchospasm and asthma symptoms¹. Cromolyn is not a rescue medication, but a maintenance medication that should be used regularly to prevent asthma attacks. The client should use Albuterol, a short acting beta agonist, to relieve acute bronchospasm and wheezing.

Choice B reason: "I will be sure to take the albuterol before taking the Atrovent." is a correct statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. Albuterol is a medication that relaxes the muscles in the airways and increases the airflow to the lungs, which can improve the breathing and reduce the wheezing in patients with asthma. Atrovent is a medication that blocks the action of acetylcholine, a neurotransmitter that causes bronchoconstriction and mucus secretion, which can worsen the asthma symptoms. The client should take the Albuterol before the Atrovent, as this will allow the Albuterol to open the airways and enhance the absorption and effectiveness of the Atrovent.

Choice C reason: "I will administer the medications 10 minutes apart." is an unnecessary statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. The client does not need to wait 10 minutes between the administration of the two medications, as they can be given together in the same nebulizer chamber. This will save time and simplify the treatment regimen for the client. The client should follow the instructions on the medication label or the prescriber's order regarding the dosage and frequency of the nebulizer treatments.

Choice D reason: "I will use both medications immediately after exercising." is an inappropriate statement for the client who has asthma and new prescriptions for Albuterol and Atrovent, both by nebulizer. The client should not use both medications immediately after exercising, as this may not prevent or relieve exercise induced bronchospasm, a condition that causes the airways to narrow during or after physical activity. The client should use Albuterol, a short acting beta agonist, before exercising, as this will prevent the bronchospasm and allow the client to exercise safely and comfortably. The client should use Atrovent, an anticholinergic, as prescribed, usually twice a day, to control the chronic symptoms of asthma.

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..