A 72-year-old client taking prednisone and levofloxacin reports a sudden pop at the back of the ankle and cannot bear weight. Which action should the nurse take?
1Apply heat, encourage range-of-motion exercises, and administer the next levofloxacin dose with food.
2Reassure the client that ankle discomfort is expected and arrange follow-up after the antibiotic course is complete.
3Stop levofloxacin, prevent weight bearing, notify the prescriber, and obtain urgent evaluation for tendon rupture.✓ Correct answer
4Massage the Achilles area, elevate the leg, and reduce the levofloxacin dose until the pain resolves.
Explanation
A sudden pop followed by inability to bear weight suggests Achilles tendon rupture. Fluoroquinolones increase the risk of tendinitis and tendon rupture, with higher risk in adults older than 60 years and clients receiving corticosteroids. Levofloxacin should be stopped, the tendon rested and protected from weight bearing, and urgent clinical evaluation obtained. Heat, massage, exercise, or continued exposure can worsen injury.
Clinical reasoning Age and corticosteroid use amplify the fluoroquinolone tendon warning. A pop and loss of function indicate rupture rather than a benign medication-related ache.
Decision rule At the first sign of tendon injury during levofloxacin therapy, stop the drug, rest and protect the affected area, and contact the prescribing team for a non-fluoroquinolone plan and evaluation.
Fluoroquinolone tendinopathy — Tendon inflammation or rupture associated with fluoroquinolone exposure, frequently involving the Achilles tendon.
Achilles tendon rupture — A tear of the tendon at the back of the ankle that can cause a sudden pop, weakness, and inability to bear weight.