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Difficulty: EasyPharmacological Therapies

While reviewing a client's health record prior to medication administration, a practical nurse (PN) observes a newly written prescription for oral cephalexin. The client's admission history indicates a severe anaphylactic reaction to amoxicillin. What is the safest course of action for the PN?

  1. Withhold the dose and immediately report the finding to the registered nurse (RN) or prescribing provider.Answer
  2. B
    Proceed with administering the antibiotic and stay with the client for 15 minutes to monitor for a rash.
  3. C
    Contact the pharmacy directly to request a substitute antibiotic from a different medication class.
  4. D
    Give the client an available as-needed (PRN) antihistamine prior to the dose to prevent an allergic response.

Answer

Withhold the dose and immediately report the finding to the registered nurse (RN) or prescribing provider.
Cephalosporins (such as cephalexin) and penicillins (such as amoxicillin) are structurally similar beta-lactam antibiotics. Clients with a history of severe allergic reactions (e.g., anaphylaxis) to penicillins have a risk of cross-sensitivity to cephalosporins. The safest and most appropriate action within the PN scope of practice is to withhold the medication and notify the RN or healthcare provider to obtain an alternative prescription.

Step-by-Step Solution

1
Identify the classifications of the prescribed medication and the client's allergen.
Cephalexin is a cephalosporin antibiotic, and amoxicillin is a penicillin antibiotic.
Understanding drug classifications is required to identify potential cross-sensitivities.
2
Determine the risk associated with administering the prescribed medication.
There is a significant risk of a cross-sensitivity allergic reaction, including anaphylaxis, between penicillins and cephalosporins.
Client safety is the top priority, and exposing the client to a known severe allergen can be fatal.
3
Select the intervention that ensures client safety while remaining within the PN scope of practice.
The PN must withhold the unsafe medication and escalate the concern to the RN or provider.
The PN is responsible for recognizing contraindications and reporting them, but cannot independently change the prescription.

Key Concept

Medication Contraindications and Cross-Sensitivity
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Topics

Pharmacological Therapies

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