Tendon pain, swelling, or a sudden pop signals possible rupture - stop the drug and report immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with a urinary tract infection is prescribed ciprofloxacin. Which instruction is most important for the nurse to include in the teaching?
Answer: B. Fluoroquinolones such as ciprofloxacin carry a risk of tendinitis and tendon rupture (notably the Achilles tendon). The client should report tendon pain or swelling and avoid strenuous exercise. Antacids and dairy can reduce absorption, so cipro should be separated from them, but the boxed-warning tendon risk is the priority safety teaching.
Question 2 of 5
A client on a fluoroquinolone antibiotic (e.g., ciprofloxacin) should report which serious effect?
Answer: B. Fluoroquinolones carry a risk of tendon rupture (especially Achilles), so report tendon pain/swelling and avoid strenuous exercise; also watch for photosensitivity and avoid taking with antacids/dairy/iron.
Question 3 of 5
A client with a UTI is prescribed ciprofloxacin. Which instruction should the nurse include in the teaching?
Answer: A. Fluoroquinolones such as ciprofloxacin should be taken with plenty of water and the client should maintain good hydration to prevent crystalluria. Antacids and dairy products containing calcium, magnesium, or iron reduce absorption and should be separated from the dose. The full course should be completed even if symptoms improve; stopping early promotes resistance.
Question 4 of 5
A client is prescribed both a fluoroquinolone antibiotic and oral calcium and iron supplements. What teaching prevents reduced antibiotic absorption?
Answer: B. Multivalent cations (calcium, iron, magnesium, aluminum, zinc) chelate fluoroquinolones and tetracyclines, reducing absorption. The client should separate the antibiotic from these products by at least 2 hours, not take them together.
Question 5 of 5
A nurse is reviewing the history of a client who is to begin ciprofloxacin therapy. Which current medication would most concern the nurse and require notification of the prescriber?
Answer: B. Fluoroquinolones inhibit metabolism of warfarin, increasing INR and bleeding risk. This combination requires close INR monitoring or a dose change. Acetaminophen, ferrous sulfate, and a multivitamin do not pose the same significant interaction (though minerals can reduce cipro absorption if taken together).
Keep the streak going with more questions like these, each with a full rationale.
What is fluoroquinolones?
They carry serious black box warnings for tendon rupture, peripheral neuropathy, and QT prolongation. The key principle is reserving them when other options fail because of these significant risks.
Key points to remember
- Fluoroquinolones are bactericidal and inhibit bacterial DNA gyrase and topoisomerase.
- They carry a black box warning for tendinitis and tendon rupture, especially the Achilles tendon.
- They can prolong the QT interval and cause dangerous arrhythmias.
- Antacids, iron, calcium, zinc, and dairy reduce absorption through chelation.
- They may cause peripheral neuropathy, CNS effects, and lower the seizure threshold.
- They can raise blood glucose or cause hypoglycemia in diabetic patients on insulin or sulfonylureas.
Nursing priorities
- Assess for and educate about tendon pain or swelling and stop the drug if it occurs.
- Separate the dose from antacids, dairy, and mineral supplements by at least 2 hours.
- Monitor the ECG and electrolytes in patients at risk for QT prolongation.
- Monitor blood glucose closely in diabetic patients.
- Encourage adequate fluid intake to prevent crystalluria.
Labs & values
Patient teaching
- Stop the medication and call your provider if you feel tendon pain or swelling, and avoid strenuous exercise.
- Avoid antacids, dairy, and iron or calcium supplements within 2 hours of the dose.
- Limit sun exposure and use sunscreen because of photosensitivity.
- Report numbness, tingling, confusion, or palpitations.
Red flags: report now
- Tendon pain, swelling, or a sudden pop signals possible rupture - stop the drug and report immediately.
- New numbness, tingling, or weakness suggests peripheral neuropathy and must be reported.
- Palpitations, syncope, or signs of arrhythmia require prompt evaluation.
References
Clinical references for this topic
