On admission, the healthcare provider prescribes a broad spectrum antibiotic for a client with a gram-negative infection. Before administering the first dose, it is most important for the nurse to implement which prescription?

Choice B reason: Ciprofloxacin is a fluoroquinolone antibiotic that can treat anthrax, a serious bacterial infection that can affect the skin, lungs, or digestive system. Ciprofloxacin can cause tendonitis or tendon rupture, especially in older adults or those who take corticosteroids. Tendonitis is the inflammation of a tendon, which is a tissue that connects muscle to bone. Tendon rupture is the tearing or breaking of a tendon. These conditions can cause severe pain, swelling, bruising, or difficulty moving the affected area. Therefore, the nurse should instruct the client to report any tendon pain or swelling to the healthcare provider immediately and stop taking ciprofloxacin until further evaluation.

Choice C reason: Increasing fluid intake while taking the medication is an instruction that should be included in the teaching plan, because ciprofloxacin can cause crystalluria, or the formation of crystals in the urine. Crystalluria can lead to kidney stones, kidney damage, or urinary tract obstruction. Therefore, the nurse should advise the client to drink at least 2 liters of water per day while taking ciprofloxacin to prevent crystalluria and maintain kidney function.

Choice E reason: Limiting exposure to sunlight and avoiding tanning beds is an instruction that should be included in the teaching plan, because ciprofloxacin can cause photosensitivity, or increased sensitivity to sunlight or artificial ultraviolet light. Photosensitivity can result in sunburn, rash, blisters, or skin discoloration. Therefore, the nurse should recommend the client to limit exposure to sunlight and avoid tanning beds while taking ciprofloxacin and for several days after finishing the course. The nurse should also suggest the client to wear protective clothing, sunglasses, and sunscreen when outdoors.

Choice A reason: Crushing and mixing the tablets with pudding if you have trouble swallowing the tablets is not an instruction that should be included in the teaching plan, but rather a contraindicated practice that can reduce the effectiveness of ciprofloxacin and increase its side effects. Ciprofloxacin tablets have a special coating that protects them from stomach acid and allows them to dissolve slowly in the intestine. Crushing them will destroy their coating and make them dissolve faster in the stomach. This can cause stomach irritation, nausea, vomiting, diarrhea, or reduced absorption of ciprofloxacin into the bloodstream. Therefore, the nurse should instruct the client to swallow the tablets whole and not chew or crush them.

Choice D reason: Using NSAIDs to relieve mild joint aches and pains caused by the medication is not an instruction that should be included in the teaching plan, but rather a risky behavior that can increase the risk of adverse effects from ciprofloxacin. NSAIDs are anti-inflammatory drugs that can reduce pain, fever, and inflammation. However, NSAIDs can also interact with ciprofloxacin and increase its concentration in the blood. This can lead to toxicity and serious side effects such as seizures, hallucinations, confusion, or liver damage. Therefore, the nurse should caution the client to avoid using NSAIDs while taking ciprofloxacin and consult with their healthcare provider before taking any other medications.

Choice A reason: Zolpidem is a hypnotic drug that induces sleep by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. Zolpidem is used to treat insomnia, or difficulty falling asleep or staying asleep. Zolpidem should be taken only at bedtime, when the client is ready to go to sleep and can devote at least seven to eight hours for uninterrupted sleep. Taking zolpidem during the day can cause excessive sedation, drowsiness, confusion, memory loss, and impaired coordination. Therefore, the nurse should encourage the client to wait until bedtime to take the medication and avoid daytime naps.

Choice B reason: Reminding the client to drink plenty of fluids when taking the medication is not an action that the nurse should take in this situation, but rather a general recommendation that applies to most medications. Drinking fluids can help to prevent dehydration, flush out toxins, and maintain kidney function. However, drinking fluids is not specific to zolpidem and does not affect its absorption or metabolism.

Choice C reason: Advising the client to take the medication with the noon meal is not an action that the nurse should take in this situation, but rather a harmful suggestion that can reduce the effectiveness of zolpidem and increase its side effects. Taking zolpidem with food can delay its onset of action and make it less potent. Taking zolpidem at noon can also interfere with the client's circadian rhythm, or natural sleep-wake cycle, and cause daytime sleepiness and nighttime insomnia.

Choice D reason: Explaining that the client needs to allow for sleep time of at least two hours is not an action that the nurse should take in this situation, but rather an inaccurate and insufficient information that can mislead the client and endanger their safety. Zolpidem has a half-life of about two hours, which means that half of its dose is eliminated from the body in two hours. However, this does not mean that its effects wear off in two hours. Zolpidem can still cause residual sedation and impairment for several hours after taking it. The client needs to allow for sleep time of at least seven to eight hours when taking zolpidem, not just two hours.