# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=514117&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

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.

Document the clarification, revised regimen, and monitoring plan in the medication record.

Notify the prescriber and pharmacist of the 39 mL/min clearance and divalproex interaction.

Hold the first meropenem dose before exposure occurs.

Administer the newly verified antimicrobial regimen and monitor renal and neurologic response.

Verify the Cockcroft-Gault calculation, infection indication, culture data, and complete medication list.

## Explanation

The sequence prevents exposure, verifies the data, obtains interdisciplinary clarification, documents the new plan, and then administers and monitors the verified regimen.

## In-depth explanation

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

## Clinical scenario

Closed-loop antimicrobial clarification
Sequence exposure prevention, complete verification, team escalation, authorized documentation, and administration of the corrected plan.

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