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Difficulty: HardPharmacological Therapies

A 78-year-old client is admitted to the medical-surgical unit for a severe urinary tract infection and has been receiving oral ciprofloxacin for the past 48 hours. The practical nurse enters the room to administer the next scheduled dose. The client, who was alert and cooperative the previous evening, is now highly agitated, disoriented to place and time, and picking aimlessly at the bed linens. What is the most appropriate action for the practical nurse to take?

  1. Withhold the antibiotic dose and immediately notify the registered nurse of the client's altered mental status.Answer
  2. B
    Administer the medication as prescribed, recognizing that episodic confusion is a normal aspect of the aging process.
  3. C
    Apply bilateral soft wrist restraints to prevent the client from pulling the linens before giving the medication.
  4. D
    Proceed with administering the antibiotic and independently hold the client's other scheduled medications.

Answer

The practical nurse should withhold the antibiotic dose and immediately notify the registered nurse of the client's altered mental status.
Acute confusion (delirium) in an older adult is a medical emergency that can indicate a severe adverse reaction to the medication, such as fluoroquinolone-induced central nervous system toxicity, or a life-threatening worsening of the underlying infection. The practical nurse must prioritize safety by withholding the scheduled drug and immediately escalating these acute neurological changes to the registered nurse for a comprehensive assessment.

Step-by-Step Solution

1
Assess the client's current clinical presentation and compare it to their baseline status.
The client exhibits a sudden onset of extreme agitation and disorientation (acute confusion), which is a significant change from being alert and cooperative.
Identifying acute changes in mental status is critical for ensuring client safety and recognizing potential complications.
2
Correlate the assessment findings with potential pharmacological complications and the underlying disease process.
Acute confusion in an older adult receiving antibiotics may indicate drug toxicity (such as central nervous system adverse effects from fluoroquinolones) or a worsening of the underlying infection (such as the development of sepsis).
Recognizing severe adverse drug reactions or condition deterioration guides the decision regarding whether to proceed with medication administration.
3
Determine the appropriate action within the practical nurse scope of practice.
The nurse must withhold the ciprofloxacin and escalate the findings to the registered nurse.
The registered nurse or healthcare provider must evaluate the acute change in condition before any further doses of potentially contributing medications are administered.

Key Concept

Pre-administration Assessment and Withholding Criteria
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Topics

Pharmacological Therapies

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