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Difficulty: EasyPharmacological and Parenteral Therapies

A nurse is reviewing the medication administration record for a client admitted with a severe lower respiratory tract infection. The client is scheduled to receive a newly prescribed dose of intravenous (IV) ceftriaxone. During the pre-administration assessment, the nurse notes that the client has a documented allergy to amoxicillin, with the reaction listed as anaphylactic shock. Which of the following actions is the priority for the nurse?

  1. Withhold the scheduled ceftriaxone dose and immediately notify the prescribing healthcare provider.Answer
  2. B
    Decrease the intravenous infusion rate by half to carefully observe the client for hypersensitivity.
  3. C
    Administer a prophylactic dose of diphenhydramine before hanging the antibiotic infusion.
  4. D
    Ensure the intravenous tubing is thoroughly flushed with normal saline to prevent any drug-drug incompatibilities.

Answer

The nurse must withhold the scheduled ceftriaxone dose and immediately notify the prescribing healthcare provider.
Ceftriaxone is a third-generation cephalosporin. Because cephalosporins and penicillins (like amoxicillin) share a structural component known as a beta-lactam ring, there is a recognized risk of cross-reactivity. For a client who has experienced an anaphylactic reaction to penicillin, cephalosporins are generally contraindicated. The safest and most appropriate action is to withhold the dose and contact the healthcare provider for an alternative prescription.

Step-by-Step Solution

1
Assess the client's allergy history and the newly prescribed medication.
The client has a severe allergy (anaphylaxis) to amoxicillin, which is a penicillin. The prescribed medication is ceftriaxone, which is a cephalosporin.
Identifying potential allergens is a critical first step in safe medication administration.
2
Recognize the pharmacological relationship between the two drug classes.
Penicillins and cephalosporins both contain a beta-lactam ring, leading to a risk of allergic cross-sensitivity.
Understanding drug classifications helps the nurse predict potential adverse reactions.
3
Determine the safest priority nursing intervention based on the assessment.
The medication must be withheld and the provider notified to request a safe alternative antibiotic.
Administering a cephalosporin to a client with a history of penicillin-induced anaphylaxis is contraindicated due to the high risk of a fatal reaction.

Key Concept

Cross-sensitivity between penicillins and cephalosporins
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Topics

Pharmacological and Parenteral Therapies

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