# A client with community-acquired bacterial pneumonia has an oral lefamulin prescription. The medication list includes pimozide, and the ECG shows a prolonged QT interval. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522999&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with community-acquired bacterial pneumonia has an oral lefamulin prescription. The medication list includes pimozide, and the ECG shows a prolonged QT interval. Which action should the nurse take?

## Option

1. Administer both drugs and recheck the ECG next year.
2. Give an extra lefamulin dose to shorten the QT interval.
3. Hold the oral lefamulin and clarify the prescription because the QT-prolonging sensitive CYP3A4 substrate combination is contraindicated. **✔ Correct answer**
4. Crush the tablet to prevent the interaction.

**Correct answer: 3**

## Explanation

Oral lefamulin is contraindicated with sensitive CYP3A4 substrates that prolong the QT interval because substrate exposure can rise and lead to torsades de pointes. Existing QT prolongation adds urgency to clarification.

## In-depth explanation

Quick answer
Hold and clarify oral lefamulin with pimozide and prolonged QT.

Why this is correct
Changing the tablet form or adding a dose does not remove the pharmacokinetic and electrophysiologic risk. The interacting regimen requires prescriber and pharmacist review before administration.

Easy analogy or mental picture
Build a medication-safety chain: identify the changing cue, connect it to the labeled toxicity or interaction, interrupt preventable exposure, stabilize the client, and verify a measurable response.

Memory hook
Drug, trend, urgent cue, protective action, and reassessment endpoint.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving indicated treatment and required monitoring.

Why the other choices are wrong
Options that continue a suspect exposure, normalize a labeled danger cue, or delay escalation leave the client at risk.References
1DailyMed: XENLETA (lefamulin)QT prolongation, contraindicated oral coadministration with QT-prolonging sensitive CYP3A4 substrates, and ECG/electrolyte risk review

## Clinical scenario

Oncology medication-safety review
Verify indication, current assessment, laboratory and oxygen trends, interactions, urgent toxicity cues, authorized action, and measurable follow-up.

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