When a client is receiving a cephalosporin, the nurse must monitor the client for which finding?

NHM MP Staff Nurse-2022

Pharmacology

Easy

Appeared in: NHM MP Staff Nurse-2022

Explanation

Cephalosporins are beta-lactam antibiotics that are structurally and pharmacologically related to penicillins.
A rare but serious adverse effect of cephalosporins is drug-induced immune hemolytic anemia (DIHA).
In DIHA, the drug triggers an immune response, causing the body to produce antibodies that attack and destroy its own red blood cells.
The nurse must monitor for signs of hemolysis, such as sudden onset of fatigue, pallor, jaundice (yellowing of the skin and eyes), and dark-colored urine.
If DIHA is suspected, the cephalosporin must be discontinued immediately, and the healthcare provider notified.

Option B: Purpura (purple-colored spots on the skin) is a sign of bleeding. While some cephalosporins can cause bleeding, it is a different mechanism than the immune-mediated destruction of red blood cells seen in hemolytic anemia.
Option C: Infectious emboli are clots containing bacteria that travel from a site of infection (e.g., infective endocarditis) to other parts of the body. This is a complication of an underlying infectious disease, not a side effect of the antibiotic used to treat it.
Option D: Ecchymosis (bruising) is also a sign of bleeding. Similar to purpura, while it can be related to certain cephalosporins that affect clotting, it is not the specific immune-mediated hemolytic reaction that is a classic, albeit rare, adverse effect of this drug class.

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse effects of cephalosporin antibiotics to guide bedside assessment, documentation, and the next nursing action.
Nurses play a critical role in identifying adverse drug reactions. When administering cephalosporins, it is vital to monitor for signs of hemolysis (jaundice, pallor, dark urine, sudden weakness) and report them immediately to the provider.
Before administering the first dose of a cephalosporin, the nurse must assess for a history of penicillin allergy due to the risk of cross-sensitivity.
Monitoring complete blood count (CBC) results, especially hemoglobin and hematocrit, can help in the early detection of hemolytic anemia.

How to Approach the Question

First, identify the drug class in the question stem: Cephalosporins.
Second, recall the key adverse effects associated with this pharmacological class. Remember that cephalosporins are beta-lactam antibiotics, similar to penicillins, and share some adverse effects.
Third, evaluate each option to determine if it represents a known adverse effect of cephalosporins.
Option A, drug-induced hemolytic anemia, is a known, serious immune-mediated reaction to beta-lactams.
Options B and D, purpura and ecchymosis, relate to bleeding. While some cephalosporins can cause this, it's a different mechanism and DIHA is a more specific immunologic complication.
Option C, infectious emboli, is a complication of an underlying disease process (like endocarditis), not a side effect of the antibiotic itself.

Concept Tested & Keywords

q4aELHWHhiWXmUknCimbf

E6 Pharmacology Katzung 16e p. 1243-1245

E6 Pharmacology Nurses Shanbhag 3e p. 299-301