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Difficulty: HardPharmacological Therapies

An older adult client residing in a long-term care facility receives daily oral prednisone for rheumatoid arthritis. The healthcare provider newly prescribes oral levofloxacin to treat a respiratory infection. Which actions should the practical nurse implement to ensure safe pharmacological management? Select all that apply.

  1. Separate the administration of the levofloxacin and the client's daily calcium supplement by at least two hours.Answer
  2. Monitor the client closely for the sudden onset of heel or ankle pain and report it immediately.Answer
  3. C
    Verify the client's identity using their full name and current room number before administering the medications.
  4. D
    Evaluate the clinical necessity of transitioning the client to an intravenous push antibiotic if symptoms do not improve.
  5. Reinforce instructions for the client to wear protective clothing and apply sunscreen when spending time outdoors.Answer
  6. F
    Inform the client's family that a sudden onset of confusion is an expected part of the aging process when fighting an infection.

Answer

The correct actions are separating the antibiotic and calcium by two hours, monitoring for heel or ankle pain, and reinforcing the need for sun protection.
Safe pharmacological management requires understanding drug-specific adverse effects and interactions. Levofloxacin binds with multivalent cations like calcium, reducing absorption, so they must be separated. Fluoroquinolones carry a black box warning for tendon rupture, and this risk is exponentially higher in older adults concurrently taking corticosteroids like prednisone. Lastly, fluoroquinolones cause photosensitivity, making sun protection teaching essential.

Step-by-Step Solution

1
Analyze the drug classifications and potential interactions.
Levofloxacin is a fluoroquinolone antibiotic. Prednisone is a corticosteroid.
Identifying the drug classes highlights specific adverse effects and administration rules.
2
Evaluate the interaction between levofloxacin, corticosteroids, and client age.
The combination of advanced age, fluoroquinolones, and corticosteroids significantly increases the risk of tendon rupture.
This establishes the critical need to monitor for joint or tendon pain, specifically in the heel or ankle.
3
Identify general administration considerations for fluoroquinolones.
They interact with cations like calcium and cause photosensitivity.
This confirms the need to separate doses from calcium supplements and reinforce sun protection teaching.
4
Assess the remaining options for adherence to safety and scope of practice.
Using a room number for identification, evaluating the need for IV push medications, and normalizing acute confusion are all unsafe or out of scope.
Distractors must be eliminated based on established practical nursing standards and physiological principles.

Key Concept

Safe administration and monitoring of fluoroquinolones and corticosteroids within the PN scope
Estimated Time:2m 0s
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Topics

Pharmacological Therapies

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