# A 35-year-old client is being discharged on metronidazole 500 mg PO three times daily for bacterial vaginosis. Which client teaching is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375248&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 35-year-old client is being discharged on metronidazole 500 mg PO three times daily for bacterial vaginosis. Which client teaching is most important?

## Option

1. Stop the medication if the urine looks darker.
2. Crush the tablet and mix with vodka for better taste.
3. Avoid all alcohol — including beer, wine, mouthwash, cough syrup with alcohol, and food prepared with wine — during therapy and for at least 48 hours after the last dose because metronidazole causes a disulfiram-like reaction with flushing, severe nausea/vomiting, headache, palpitations, and hypotension; report metallic taste and dark urine which can be normal but report any neurologic symptoms; complete the prescribed course and avoid pregnancy in first trimester. **✔ Correct answer**
4. It is fine to drink alcohol with this medication.

**Correct answer: 3**

## Explanation

Metronidazole is used for anaerobic infections, bacterial vaginosis, trichomoniasis, C. difficile (oral vancomycin or fidaxomicin now preferred for CDI), Helicobacter pylori, intra-abdominal and pelvic infections, and giardiasis. Key teaching: (1) disulfiram-like reaction with alcohol — even small amounts in mouthwash, cough syrup, or food cooked with wine can cause flushing, severe nausea and vomiting, headache, palpitations, hypotension, dyspnea, and rarely fatal arrhythmia; avoid alcohol during therapy and for at least 48 hours after the last dose (some sources extend to 72 hours); educate patient and family thoroughly; (2) common side effects — metallic taste, nausea, GI upset, dry mouth, dark or reddish-brown urine (harmless from drug metabolites but report any change to ensure no other cause); (3) CNS — dizziness, headache, peripheral neuropathy with prolonged use, rarely seizures or aseptic meningitis; (4) drug interactions — warfarin (INR up), lithium (toxicity), phenytoin, busulfan; (5) avoid in first trimester pregnancy when possible; (6) complete the full course on schedule. Drinking alcohol, mixing with vodka, and stopping for dark urine are unsafe.

## In-depth explanation

No alcohol with metronidazole, including 48 hours after the last dose. Disulfiram-like reaction is the high-yield NCLEX answer. Dark urine is harmless.

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