# A 72-year-old client on chronic prednisone is started on levofloxacin for pneumonia. On day 4 the client reports sudden right Achilles pain with a "popping" sensation while walking and is unable to weight-bear. Which is the priority nursing action? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375230&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 72-year-old client on chronic prednisone is started on levofloxacin for pneumonia. On day 4 the client reports sudden right Achilles pain with a "popping" sensation while walking and is unable to weight-bear. Which is the priority nursing action? ## Option 1. Continue levofloxacin as prescribed to complete the full course because stopping early may promote antibiotic resistance; add azithromycin to provide atypical coverage for community-acquired pneumonia, and manage the Achilles pain with rest, ice, and elevation, scheduling an orthopedic follow-up after the antibiotic is finished. 2. Reassure the client that fluoroquinolones commonly cause transient muscle aches and that the popping sensation is likely due to joint crepitus; continue levofloxacin for the remaining 3 days as prescribed and advise the client to take over-the-counter analgesics, apply warm compresses, and limit stair climbing for 48 hours. 3. Stop the levofloxacin immediately, notify the prescriber, immobilize the affected leg without weight-bearing, elevate, apply ice, prepare for orthopedic evaluation/imaging because the presentation is highly suggestive of fluoroquinolone-induced Achilles tendon rupture; switch to a non-fluoroquinolone antibiotic guided by culture/susceptibility. **✔ Correct answer** 4. Instruct the client to apply a heating pad to the posterior ankle for 20 minutes every 4 hours to increase blood flow and promote healing, and encourage progressive weight-bearing as tolerated to prevent deconditioning, while scheduling a physical therapy evaluation for gait training and strengthening exercises after the pneumonia resolves. **Correct answer: 3** ## Explanation Fluoroquinolones carry an FDA black box warning for tendinitis and tendon rupture, most commonly involving the Achilles tendon but also rotator cuff, biceps, hand, and other tendons. Risk factors: age over 60, concurrent systemic corticosteroids, kidney/heart/lung transplantation, prior tendon disorders, strenuous activity. Onset can occur within hours to weeks and even months after the drug. Presentation: sudden tendon pain, swelling, "snap" or "pop" sensation, inability to bear weight or use the affected limb. Standard nursing response: (1) stop the fluoroquinolone immediately, (2) notify the prescriber for evaluation, (3) protect the limb with rest, immobilization, ice, elevation, and avoidance of weight-bearing or strenuous use, (4) anticipate orthopedic consult and ultrasound or MRI for diagnosis, surgical or non-surgical management depending on severity and patient factors, (5) change to a non-fluoroquinolone antibiotic guided by culture and susceptibility, (6) avoid future fluoroquinolone exposure when possible, document the adverse event, (7) educate the client about persistent risk for months after discontinuation. Reassuring and continuing, applying heat with ambulation, and adding more fluoroquinolone are unsafe. ## In-depth explanation Suspect tendon rupture in an elderly steroid user on a fluoroquinolone with a sudden snap. Stop the drug, immobilize, refer to ortho. 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