A patient with renal impairment is prescribed a medication that is primarily excreted by the kidneys. What adjustment should the nurse anticipate?

Choice A reason: Tinnitus is a rare side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Tinnitus is a ringing or buzzing sound in the ears that can be caused by various factors, such as ear infections, noise exposure, or certain medications. Flexeril does not affect the auditory system directly, but it can cause confusion or dizziness, which may worsen the perception of tinnitus.

Choice B reason: Drowsiness is the most common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Drowsiness occurs because Flexeril has sedative and anticholinergic properties, which means that it blocks the action of acetylcholine, a neurotransmitter that regulates arousal and alertness. Flexeril can impair the mental and physical abilities, especially in elderly patients or those who take other medications that cause drowsiness¹. The nurse should educate the patient about the risk of drowsiness and advise them to avoid driving or operating machinery while taking Flexeril.

Choice C reason: Diarrhea is not a common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Diarrhea is a condition that causes loose or watery stools, which can be caused by various factors, such as infections, food intolerance, or certain medications. Flexeril does not affect the gastrointestinal system directly, but it can cause dry mouth, nausea, or constipation, which may alter the bowel movements¹.

Choice D reason: Palpitations are not a common side effect of Flexeril, which is a medication that relaxes the muscles and relieves pain and stiffness¹. Palpitations are a sensation of rapid or irregular heartbeat, which can be caused by various factors, such as stress, anxiety, caffeine, or certain medications. Flexeril does not affect the cardiac system directly, but it can lower the blood pressure or interact with other medications that affect the heart rate, such as betablockers or antidepressants¹.

Choice A reason: Ancef (ciprofloxacin) is not the correct answer for the nurse who anticipates administering a broad-spectrum antibiotic to a client diagnosed with a beta lactam resistant bacteria. Ancef is the brand name of cefazolin, which is a firstgeneration cephalosporin, a subclass of beta lactam antibiotics. Cefazolin is effective against gram-positive bacteria, but has limited activity against gram negative bacteria and anaerobes. Cefazolin is also susceptible to beta-lactamase enzymes, which are produced by some bacteria to degrade beta lactam antibiotics and confer resistance. The nurse should avoid using Ancef or any other beta lactam antibiotic for a client with a beta lactam resistant bacteria.

Choice B reason: Merrem (meropenem) is the correct answer for the nurse who anticipates administering a broad-spectrum antibiotic to a client diagnosed with a beta lactam resistant bacteria. Merrem is the brand name of meropenem, which is a carbapenem, a subclass of beta lactam antibiotics. Meropenem is effective against a wide range of bacteria, including gram-positive, gram negative, and anaerobic bacteria. Meropenem is also resistant to most beta-lactamase enzymes, except for metallo-beta-lactamase’s, which are rare and can be detected by laboratory tests. The nurse should consider using Merrem or another carbapenem for a client with a beta lactam resistant bacteria, unless they have a history of allergy or intolerance to beta lactam antibiotics .

Choice C reason: Flagyl (metronidazole) is not the correct answer for the nurse who anticipates administering a broad spectrum antibiotic to a client diagnosed with a beta lactam resistant bacteria. Flagyl is the brand name of metronidazole, which is a nitroimidazole antibiotic. Metronidazole is effective against anaerobic bacteria and some protozoa, but has no activity against aerobic bacteria. Metronidazole is not a beta lactam antibiotic, and it is not affected by beta-lactamase enzymes. However, metronidazole is not a broad spectrum antibiotic, and it is not suitable for treating infections caused by aerobic bacteria, which are more common than anaerobic bacteria. The nurse should use Flagyl only for specific indications, such as bacterial vaginosis, trichomoniasis, or Clostridioides difficile infection .

Choice D reason: Zosyn (piperacillin tazobactam) is not the correct answer for the nurse who anticipates administering a broad-spectrum antibiotic to a client diagnosed with a beta lactam resistant bacterium. Zosyn is the brand name of piperacillin tazobactam, which is a combination of penicillin, a subclass of beta lactam antibiotics, and a beta-lactamase inhibitor. Piperacillin is effective against some gram-positive and gram-negative bacteria, but it is susceptible to beta-lactamase enzymes. Tazobactam is a compound that binds to and inhibits some beta-lactamase enzymes, thereby protecting piperacillin from degradation and extending its spectrum of activity. However, piperacillin tazobactam is not effective against all types of beta-lactamase enzymes, especially those that are encoded by plasmids and can be transferred between bacteria. The nurse should not use Zosyn or any other beta lactam/beta-lactamase inhibitor combination for a client with a beta lactam resistant bacterium unless the specific type of beta-lactamase is known and susceptible to the inhibitor.