While a patient is receiving a statin, the nurse knows to monitor the patient closely for the development of which problem?

Choice A reason: Antibiotics prescribed based on culture and sensitivity reports target specific bacterial susceptibilities, minimizing resistance. Appropriate use ensures effective bacterial killing, reducing the survival of resistant mutants. This practice aligns with antimicrobial stewardship, preventing the selection pressure that drives resistance development.

Choice B reason: Prescribing antibiotics for viral infections promotes resistance, as antibiotics do not affect viruses. Unnecessary exposure allows bacteria to develop resistance mechanisms, like beta-lactamase production, reducing future antibiotic efficacy. This misuse is a major contributor to the global rise of resistant bacterial strains.

Choice C reason: Taking antibiotics and antivirals together does not inherently cause resistance. Antibiotics target bacteria, and antivirals target viruses, with no direct interaction promoting bacterial resistance. Resistance arises from inappropriate antibiotic use, not combination with antivirals, making this situation irrelevant to resistance development.

Choice D reason: Microorganisms from foreign countries may carry resistance genes, but this describes transmission, not the mechanism of resistance development. Resistance occurs due to antibiotic misuse or overuse, not solely from geographic spread, making this less directly related to the situations causing resistance.

Choice E reason: Stopping antibiotics prematurely allows surviving bacteria to develop resistance. Incomplete treatment reduces antibiotic pressure, enabling bacteria to adapt through mutations or gene transfer, like plasmid-mediated resistance. Full-course adherence ensures bacterial eradication, preventing the emergence of resistant strains, making this a critical factor.

Choice A reason: Monitoring alone is insufficient with elevated ALT and AST, indicating liver dysfunction. Metronidazole is metabolized by the liver, and hepatotoxicity is a known risk. Administering it to a patient with pre-existing liver damage could worsen hepatic injury, making this action inadequate.

Choice B reason: Elevated ALT and AST suggest liver dysfunction, and metronidazole, metabolized hepatically, can exacerbate hepatotoxicity. Avoiding administration prevents further liver damage, as the drug’s nitroimidazole structure undergoes hepatic reduction, producing toxic metabolites that stress an already compromised liver, necessitating alternative therapy.

Choice C reason: Reducing the metronidazole dose is not recommended without medical consultation. Elevated liver enzymes indicate impaired hepatic function, and even reduced doses may worsen hepatotoxicity. Alternative antibiotics with less hepatic metabolism should be considered, making dose reduction an unsafe choice.

Choice D reason: Administering metronidazole as prescribed is dangerous with elevated ALT and AST, signaling liver dysfunction. Metronidazole’s hepatic metabolism can exacerbate liver injury, increasing the risk of severe hepatotoxicity. The nurse should withhold the drug and consult the prescriber for safer alternatives.