A nurse is caring for a client who has a prescription for acyclovir IV three times daily.
Which of the following actions should the nurse take?

Choice A rationale

Constipation is not a commonly associated adverse effect of ciprofloxacin. Fluoroquinolones primarily impact gastrointestinal motility through alterations in gut flora and direct irritation, often leading to diarrhea or abdominal discomfort rather than constipation. The drug's mechanism does not typically promote slowed bowel movements or decreased peristalsis.

Choice B rationale

Weight gain is not a typical adverse effect of ciprofloxacin. Fluoroquinolones do not directly influence metabolic pathways or fluid retention in a manner that would lead to increased body mass. Adverse effects are usually related to gastrointestinal disturbances, neurological effects, or musculoskeletal issues.

Choice C rationale

Phototoxicity is a significant adverse effect of ciprofloxacin, a fluoroquinolone antibiotic. This occurs due to the drug's ability to absorb ultraviolet radiation, leading to a photochemical reaction that damages skin cells. This damage can manifest as severe sunburn, blistering, or rash upon exposure to sunlight.

Choice D rationale

Bradycardia is not a recognized adverse effect of ciprofloxacin. While some antibiotics can rarely affect cardiac conduction, ciprofloxacin's primary cardiovascular concerns relate more to QT prolongation and potential arrhythmias, not typically a decrease in heart rate. Its mechanism does not directly depress sinoatrial node function.

The client is at risk for developing hallucinations and weight loss.

Rationale for correct answers:
Bupropion is an atypical antidepressant used for smoking cessation that acts by inhibiting the reuptake of norepinephrine and dopamine. It is known to potentially cause neuropsychiatric side effects, including hallucinations, especially in patients with a history of psychiatric disorders such as bipolar disorder. Weight loss is a common adverse effect due to bupropion’s appetite suppression and increased metabolism. Normal weight is assessed by BMI, and this client has a normal BMI, but bupropion may exacerbate weight loss. Hallucinations indicate serious CNS involvement and require close monitoring.

Rationale for incorrect Response 1 options:
Dependence is not typically associated with bupropion; it has a low abuse potential. Somnolence or drowsiness is not a prominent side effect; bupropion is generally stimulating rather than sedating. Hypotension is also not a common effect; bupropion may actually increase heart rate and blood pressure slightly.

Rationale for incorrect Response 2 options:
Somnolence is not common; patients may experience insomnia rather than sedation. Hallucinations are already selected as a correct response. Hypotension is rare; instead, bupropion can cause hypertension in some cases. Weight loss is a known side effect and thus the correct choice.

Take home points:

• Bupropion can cause neuropsychiatric side effects, especially in clients with bipolar disorder.
• Weight loss may occur due to appetite suppression and increased metabolism.
• Monitor closely for CNS symptoms such as hallucinations during therapy.
• Smoking cessation pharmacotherapy must be tailored considering psychiatric history to avoid adverse effects.