# Clinical context A 59-year-old taking sertraline daily and tramadol as needed is prescribed linezolid for a resistant infection; the first dose has not been given and the nurse is reconciling medicines and monitoring risks. A client takes sertraline and tramadol. Linezolid is prescribed for a resistant infection. Which actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522091&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
A 59-year-old taking sertraline daily and tramadol as needed is prescribed linezolid for a resistant infection; the first dose has not been given and the nurse is reconciling medicines and monitoring risks.

A client takes sertraline and tramadol. Linezolid is prescribed for a resistant infection. Which actions are appropriate? Select all that apply.

1Hold the first linezolid dose and clarify the serotonergic medication plan.
2Review the need for tramadol and other serotonergic or interacting medicines.
3Monitor for agitation, diaphoresis, fever, clonus, tremor, and hyperreflexia.
4Teach the client to self-increase tramadol if pain rises during antibiotic therapy.
5Escalate promptly if neuromuscular or autonomic findings develop.
6Assume serotonin syndrome cannot occur with an antimicrobial.
7Continue linezolid with both serotonergic medicines without a monitoring plan as long as the client remains afebrile.
8Treat new clonus and diaphoresis with an antihistamine alone and wait until the next routine visit.

## Explanation

Linezolid has monoamine oxidase-inhibiting activity and can precipitate serotonin syndrome with serotonergic drugs, including opioids; the regimen requires clarification and active monitoring.

## In-depth explanation

Quick answer
Prevent serotonergic accumulation and delayed recognition.

Why this is correct
Medication review and symptom surveillance are essential when linezolid is considered for a client receiving sertraline and tramadol.

Easy analogy or mental picture
Treat medication safety like airway triage: identify the threat, interrupt exposure, support physiology, and verify a durable response.

Memory hook
Cue, risk, action, response, recurrence check.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving reassessment and escalation.

Why the other choices are wrong
Options that normalize deterioration, add interacting medication, or delay rescue leave the safety loop open.References
1DailyMed: ZYVOX (linezolid)Serotonin syndrome risk with serotonergic medicines including opioids and required monitoring

## Clinical scenario

Clinical context
A 59-year-old taking sertraline daily and tramadol as needed is prescribed linezolid for a resistant infection; the first dose has not been given and the nurse is reconciling medicines and monitoring risks.

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