A 78-year-old client weighing 72 kg has a culture-supported complicated intra-abdominal infection, creatinine clearance of 39 mL/min, a new meropenem 1 g IV every-8-hours order, and chronic divalproex therapy for a seizure disorder. Place the nursing actions in order after identifying the unsafe first-dose plan.
Ordered Response
Choose your responses, then check the answer.
Explanation
The sequence prevents exposure, verifies the data, obtains interdisciplinary clarification, documents the new plan, and then administers and monitors the verified regimen.
Quick answer Use hold - verify - escalate - document - administer and monitor.
Why this is correct The nurse first prevents a potentially unsafe dose. Rapid verification makes the call precise, the prescriber and pharmacist resolve selection and dosing, and administration occurs only after a clear revised order exists.
Easy analogy or mental picture Close the gate, check the manifest, call the route planners, record the route, then send the vehicle.
Memory hook Prevent exposure before completing the correction workflow.
NCLEX decision rule Order medication-safety actions by immediate harm prevention, data verification, authorized correction, documentation, and monitored treatment.
Why the other choices are wrong Administering before clarification defeats the safety process; documentation alone cannot authorize a revised regimen.
References
1DailyMed: Meropenem for InjectionCockcroft-Gault renal schedule, seizure potential, and valproate interaction
2Valproate Interaction With Carbapenems: Review and RecommendationsPeer-reviewed synthesis of subtherapeutic valproate and breakthrough seizure risk
Closed-loop antimicrobial clarificationSequence exposure prevention, complete verification, team escalation, authorized documentation, and administration of the corrected plan.