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Difficulty: HardPharmacological Therapies

An 68-year-old client is receiving treatment for a respiratory infection. The client's medication administration record includes a scheduled oral prednisone taper and a recently prescribed course of oral levofloxacin. While walking to the restroom, the client suddenly reports severe, sharp pain and swelling in the back of the right ankle. Which action should the practical nurse take?

  1. Instruct the client to avoid bearing weight on the right foot, withhold the levofloxacin, and notify the registered nurse.Answer
  2. B
    Administer a prescribed as-needed analgesic for the ankle pain and encourage the client to continue walking to prevent immobility complications.
  3. C
    Administer the scheduled medications and independently initiate a physical therapy consultation to evaluate the new-onset mobility impairment.
  4. D
    Expedite administration of the levofloxacin by verifying the client's identity using the room number so the client can promptly return to bed and rest.

Answer

The practical nurse should instruct the client to avoid bearing weight on the affected foot, withhold the levofloxacin, and immediately notify the registered nurse.
Levofloxacin is a fluoroquinolone antibiotic associated with a severe risk of tendinitis and tendon rupture, most commonly affecting the Achilles tendon. This risk is exponentially increased in clients over the age of 60 and those receiving concurrent corticosteroid therapy, such as prednisone. Because the client is exhibiting classic signs of Achilles tendon injury (sudden sharp pain and swelling in the heel area), the practical nurse must immediately withhold the levofloxacin to prevent further toxicity, instruct the client not to bear weight on the foot to prevent a full rupture, and notify the registered nurse so a comprehensive assessment can be performed.

Step-by-Step Solution

1
Identify the pharmacological risk factors presented in the clinical scenario.
The client is an older adult taking levofloxacin (a fluoroquinolone) and prednisone (a corticosteroid).
Fluoroquinolones carry a black box warning for tendinitis and tendon rupture. This risk is significantly heightened in clients over age 60 and those taking concurrent corticosteroids.
2
Correlate the client's new symptoms with the pharmacological risk profile.
The sudden, sharp pain and swelling in the back of the right ankle strongly suggests Achilles tendinitis or an impending tendon rupture.
Recognizing adverse drug reactions is a critical component of safe medication administration and continuous client monitoring.
3
Determine the appropriate practical nursing intervention based on safety and scope of practice.
The nurse must prevent further musculoskeletal injury by restricting weight-bearing, withhold the offending medication, and escalate the acute clinical change to the registered nurse.
The LPN/LVN is strictly responsible for withholding unsafe medications and promptly reporting acute condition changes to the RN or provider for further medical assessment.

Key Concept

Pharmacological Therapies: Adverse Effects and Scope of Practice
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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