A nurse is assessing a client who has a positive Trousseau's sign.
Which of the following medications should the nurse plan to administer?

Choice A rationale

Acetaminophen is an analgesic and antipyretic that primarily inhibits prostaglandin synthesis in the central nervous system. It does not significantly interact with clopidogrel, an antiplatelet medication, regarding its antiplatelet activity or bleeding risk. Therefore, reporting acetaminophen use to the provider is generally not a high priority unless liver concerns exist.

Choice B rationale

Valerian is an herbal supplement commonly used for sleep and anxiety. It primarily interacts with gamma-aminobutyric acid (GABA) receptors in the brain. There is no significant scientific evidence or known pharmacokinetic interaction between valerian and clopidogrel that would necessitate reporting its use to the provider due to increased bleeding risk.

Choice C rationale

Vitamin B refers to a group of water-soluble vitamins crucial for various cellular metabolic processes. Generally, vitamin B supplements do not have a known significant interaction with clopidogrel that would alter its antiplatelet effect or increase bleeding risk. Therefore, taking vitamin B is not typically a concern to report.

Choice D rationale

Ginkgo biloba is an herbal supplement known for its antiplatelet properties due to its ability to inhibit platelet-activating factor. Concomitant use with clopidogrel, another potent antiplatelet agent, significantly increases the risk of bleeding. This synergistic effect on platelet aggregation warrants immediate reporting to the provider for assessment and potential dosage adjustments.

Choice A rationale

Calcium levels are primarily regulated by parathyroid hormone and calcitonin and are essential for bone health and muscle function. Neither lovastatin nor ezetimibe directly impacts calcium metabolism to a degree that requires routine monitoring of serum calcium levels. Calcium monitoring is not a primary concern for these lipid-lowering medications.

Choice B rationale

Creatinine clearance is a measure of renal function, reflecting the kidney's ability to filter waste products from the blood. While some medications can affect kidney function, lovastatin and ezetimibe do not typically have significant nephrotoxic effects that necessitate routine monitoring of creatinine clearance unless pre-existing renal impairment is present.

Choice C rationale

Thyroid stimulating hormone (TSH) is produced by the pituitary gland and regulates thyroid hormone production. There is no direct pharmacological mechanism by which lovastatin or ezetimibe would significantly alter thyroid function or TSH levels. Therefore, TSH monitoring is not a standard requirement for these lipid-lowering therapies.

Choice D rationale

Both lovastatin (a statin) and ezetimibe can, albeit rarely, cause liver dysfunction, including elevated liver enzymes. Alanine aminotransferase (ALT) is a specific indicator of hepatocellular injury. Monitoring ALT is crucial to detect potential drug-induced hepatotoxicity, particularly with combination therapy, ensuring early intervention if liver damage occurs. Normal ALT is typically 7-55 U/L.