A preoperative client reports urticaria after penicillin 20 years ago, and cefazolin is prescribed for surgical prophylaxis. Which action should the nurse take?
1Request vancomycin and document that all beta-lactam antibiotics are permanently contraindicated.
2Premedicate with diphenhydramine and administer cefazolin without clarifying the previous reaction.
3Ignore the remote reaction and administer cefazolin without updating the allergy history.
4Document the reaction details and collaborate with the prescriber and pharmacist to verify the cefazolin plan.✓ Correct answer
Explanation
The nurse should clarify and document the timing, symptoms, and severity of the reported reaction and communicate with the prescriber and pharmacist. Cefazolin has a dissimilar side chain from penicillins and can often be used safely in clients with a penicillin allergy history, but severe delayed reactions and drug-specific histories still require careful review. Automatically substituting vancomycin is unnecessary, while premedicating or ignoring the history bypasses an appropriate allergy assessment.
Clinical reasoning summary Do not automatically exclude every beta-lactam or ignore the allergy history. Clarify and document the prior reaction, then coordinate with the prescriber and pharmacist. Cefazolin's distinct side chain generally makes penicillin cross-reactivity low, while severe delayed reactions require special caution.