A 79-year-old patient is receiving levofloxacin as treatment for a complicated infection. The nurse will monitor for which adverse effect that is associated with this drug?

Tendonitis and tendon rupture

Hypotension and tachycardia

Double vision and floaters

Numbness and tingling

Answer and Explanation

The Correct Answer is A

Choice A reason: Levofloxacin, a fluoroquinolone, is associated with tendonitis and tendon rupture, particularly in older adults. It disrupts collagen synthesis, weakening tendons like the Achilles, especially in patients over 60 or on corticosteroids. Monitoring for tendon pain is critical to prevent debilitating injury during therapy.

Choice B reason: Hypotension and tachycardia are not primary adverse effects of levofloxacin. Fluoroquinolones may cause QT prolongation, but cardiovascular effects are rare. Their main toxicities include tendon damage and CNS effects, making this an incorrect choice for monitoring in this patient.

Choice C reason: Double vision and floaters are not typical levofloxacin side effects. Fluoroquinolones may cause CNS effects like dizziness or confusion, but visual disturbances like these are more associated with drugs like chloroquine. Tendon issues are a more significant concern with levofloxacin.

Choice D reason: Numbness and tingling are not common with levofloxacin. While fluoroquinolones can cause CNS side effects like seizures in rare cases, peripheral neuropathy is less frequent. Tendonitis and rupture are more prominent risks, especially in older patients, making this an incorrect monitoring priority.

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Correct Answer is A

Explanation

Choice A reason: Massaging the injection site after enoxaparin administration is incorrect, as it can increase the risk of hematoma formation. Enoxaparin, a low-molecular-weight heparin, is absorbed subcutaneously without massage, which may disrupt tissue and enhance bleeding risk, a critical concern in anticoagulant therapy.

Choice B reason: Administering enoxaparin at a 90-degree angle is correct for subcutaneous injections. This ensures the drug reaches the subcutaneous tissue, optimizing absorption and anticoagulant activity. Enoxaparin inhibits factor Xa, preventing thrombus formation, and proper injection technique is essential for effective DVT prophylaxis.

Choice C reason: Injecting enoxaparin at least 2 inches from the umbilicus is correct to avoid areas with high vascularity or scar tissue, reducing the risk of bruising or poor absorption. This ensures consistent drug delivery into subcutaneous tissue, maintaining therapeutic levels for DVT prevention.

Choice D reason: Rotating injection sites for enoxaparin is appropriate to prevent tissue irritation or lipodystrophy. Alternating sites, such as the abdomen or thighs, ensures consistent absorption and minimizes local complications, supporting safe administration of this anticoagulant for DVT prophylaxis.

A. Immediate B. 5 to 10 minutes C. 20 minutes D. 1 hour

Correct Answer is A

Explanation

Choice A reason: Intravenous heparin has an immediate onset, as it rapidly enhances antithrombin activity, inhibiting thrombin and factor Xa, preventing clot formation. This quick action makes it ideal for acute conditions like pulmonary embolism, providing instant anticoagulation, with effects measurable by aPTT within minutes of administration.

Choice B reason: A 5- to 10-minute onset is too slow for IV heparin, which acts immediately upon entering the bloodstream. Subcutaneous heparin has a delayed onset (20-60 minutes), but IV delivery ensures rapid anticoagulant effects, making this timeframe incorrect for IV administration.

Choice C reason: A 20-minute onset is inaccurate for IV heparin. Its immediate binding to antithrombin provides instant anticoagulation, unlike oral anticoagulants like warfarin, which take days. The 20-minute timeframe may apply to subcutaneous heparin, not IV, which acts within seconds to minutes.

Choice D reason: A 1-hour onset is incorrect for IV heparin, which provides immediate anticoagulation by enhancing antithrombin’s inhibition of clotting factors. This rapid action is critical for acute thrombotic conditions. A 1-hour delay applies to drugs with slower absorption, not IV heparin’s direct action.

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A 79-year-old patient is receiving levofloxacin as treatment for a complicated infection. The nurse will monitor for which adverse effect that is associated with this drug?

Nursing Test Bank

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