A client has a prescription for clopidogrel bisulfate 75 mg by mouth daily at 0900. In which situation should the nurse hold this medication?

Elective surgery is scheduled in two hours.

An abdominal sonogram is scheduled.

Breakfast has not been eaten.

The client's platelet level is high.

Answer and Explanation

The Correct Answer is A

A. Elective surgery is scheduled in two hours: Clopidogrel is an antiplatelet agent that significantly increases the risk of bleeding. It should be held prior to surgery to minimize intraoperative and postoperative bleeding risks. Surgeons often require clopidogrel to be discontinued several days in advance, making it critical to withhold the drug if surgery is imminent.

B. An abdominal sonogram is scheduled: An abdominal ultrasound is a noninvasive imaging test that does not carry bleeding risks. There is no need to hold clopidogrel prior to sonogram procedures because it does not impact the safety or accuracy of the imaging study.

C. Breakfast has not been eaten: Clopidogrel can be taken with or without food. Skipping a meal does not contraindicate administering the medication, although taking it with food can sometimes help reduce gastrointestinal discomfort.

D. The client's platelet level is high: Clopidogrel works by inhibiting platelet aggregation, not by lowering platelet count. A high platelet count alone is not a reason to withhold the medication unless there is a specific bleeding risk or another contraindication identified by the healthcare provider.

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Correct Answer is C

Explanation

A. Palpate eyelids for decreased swelling: Pilocarpine is used to lower intraocular pressure in glaucoma by promoting aqueous humor drainage; it does not primarily target eyelid swelling. Palpating the eyelids would not provide relevant information about the drug’s effectiveness.

B. Check amount of drainage from each eye: Drainage from the eyes may suggest infection or irritation but is not a measure of how well pilocarpine is controlling intraocular pressure. Monitoring drainage does not directly assess the therapeutic effect of a miotic agent.

C. Review eye pressure measurements: The primary goal of pilocarpine therapy in open-angle glaucoma is to lower intraocular pressure (IOP) to prevent optic nerve damage and preserve vision. Evaluating IOP measurements directly assesses the effectiveness of the medication in achieving its intended outcome.

D. Use Snellen chart to assess visual acuity: While maintaining vision is a long-term goal in glaucoma management, changes in visual acuity do not immediately reflect the effectiveness of pilocarpine. Vision loss occurs over time if IOP is not controlled, making pressure monitoring a more immediate and sensitive indicator.

A. Hold the dose and notify the healthcare provider (HCP) of the changes in the laboratory studies. B. Hold the dose and notify the pharmacy to stop dispersing the next premixed doses. C. Begin the infusion and submit a drug reaction report to the nursing supervisor. D. Begin the infusion and monitor the client's blood urea nitrogen (BUN), serum creatinine, and liver function tests.

Correct Answer is A

Explanation

A. Hold the dose and notify the healthcare provider (HCP) of the changes in the laboratory studies: Fluconazole is hepatotoxic and can cause elevations in liver enzymes, including AST. A rising trend in liver enzymes suggests possible liver injury, and administering another dose without medical clearance could worsen hepatic damage. Immediate communication with the HCP is the safest and most appropriate action.

B. Hold the dose and notify the pharmacy to stop dispersing the next premixed doses: Although stopping further dispensing may eventually be needed if the drug is discontinued, the pharmacy cannot make this clinical decision. Notifying the HCP for evaluation and new orders must take priority.

C. Begin the infusion and submit a drug reaction report to the nursing supervisor: Initiating the infusion despite abnormal liver function tests can endanger the client. Reporting an adverse reaction to the supervisor is important after ensuring the client’s safety, but the infusion should be held first pending provider instructions.

D. Begin the infusion and monitor the client's blood urea nitrogen (BUN), serum creatinine, and liver function tests: While monitoring labs is critical during fluconazole therapy, starting the infusion in the presence of worsening liver enzyme trends without provider approval can increase the risk of serious hepatic complications.

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A client has a prescription for clopidogrel bisulfate 75 mg by mouth daily at 0900. In which situation should the nurse hold this medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with open-angle glaucoma is using pilocarpine opthalmic solution, a miotic agent. Which action should the nurse at the eye clinic include in evaluating the effectiveness of the medication?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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