Question

a nurse at an urgent care clinic is collecting a history from a client who has a urinary tract infection. the nurse anticipates a prescription for ciprofloxacin. the nurse should identify that which of the following client statements indicates a contraindication for administering this medication?

\i have tendonitis, so i havent been able to exercise.\
\i take a stool softener for chronic constipation.\
\i take medicine for my thyroid.\
\i am allergic to sulfa.\

Explanation:

Analyze the clinical scenario

The clinical scenario describes a nurse collecting a history from a client with a urinary tract infection (UTI) who is anticipated to receive a prescription for ciprofloxacin. We need to identify which client statement indicates a contraindication or a major warning/precaution that would contraindicate administering this medication.

Evaluate the drug profile of ciprofloxacin

Ciprofloxacin is a fluoroquinolone antibiotic. Fluoroquinolones carry a black box warning due to the increased risk of tendinitis and tendon rupture. This risk is further elevated in patients who already have active tendonitis, are elderly, are taking corticosteroids, or have undergone organ transplants. Therefore, a history of active tendonitis is a key contraindication/precaution for prescribing ciprofloxacin.

Assess the client statements

• "I have tendonitis, so I haven't been able to exercise.": This directly relates to the black box warning for fluoroquinolones regarding tendinitis and tendon rupture. Administering ciprofloxacin to a patient with active tendonitis is contraindicated due to the high risk of tendon rupture.
• "I take a stool softener for chronic constipation.": Stool softeners (like docusate sodium) do not have a known clinically significant interaction or contraindication with ciprofloxacin.
• "I take medicine for my thyroid.": Thyroid hormones (like levothyroxine) can have absorption interactions with certain medications, but thyroid disease or taking thyroid hormone replacement is not a direct contraindication for ciprofloxacin.
• "I am allergic to sulfa.": Ciprofloxacin is a fluoroquinolone, not a sulfonamide (sulfa) drug. A sulfa allergy is not a contraindication for ciprofloxacin.

Formulate the final clinical decision

The statement indicating a contraindication is the one regarding tendonitis, as fluoroquinolones can cause tendon rupture and worsen existing tendinitis.

Answer:

• "I have tendonitis, so I haven't been able to exercise." (Correct answer)
• "I take a stool softener for chronic constipation."
• "I take medicine for my thyroid."
• "I am allergic to sulfa."