A nurse is caring for a client who has heart failure and is taking hydrochlorothiazide. The nurse should monitor the client for which of the following manifestations as an adverse effect of the medication?

Choice A Reason:
. "I will check the client's INR before administering the heparin." Is incorrect. Checking the client's INR (International Normalized Ratio) is essential, but it's more applicable for monitoring anticoagulants like warfarin, not heparin. Heparin's effect is typically monitored via activated partial thromboplastin time (aPTT) or anti-Xa levels, not INR.
Choice B Reason:
"I will aspirate before administering the heparin." Is incorrect. Aspirating before administering heparin injections is not necessary because the medication is given subcutaneously or intravenously and not into a blood vessel.
Choice C Reason:
"I will massage the site after injecting the heparin." Is incorrect. Massaging the site after injecting heparin could increase the risk of bruising or hematoma formation at the injection site. It's generally advised to avoid massaging the area after a heparin injection to prevent tissue trauma.
Choice D Reason:
"I will apply pressure for 1 minute after the injection." Is correct. Applying pressure to the injection site for about a minute after administering heparin helps minimize the risk of bleeding or hematoma formation, especially with subcutaneous injections. This practice aids in reducing bleeding at the injection site.

Choice A Reason:
Giving the prescribed dose of clindamycin is not appropriate due to the reported penicillin allergy, which increases the risk of an allergic reaction.
Choice B Reason:
Obtain a prescription for an alternative antibiotic is correct. Given the client's reported allergy to penicillin, which is in the same antibiotic class as clindamycin (both are antibiotics that belong to the beta-lactam group), there is a higher risk of cross-reactivity and potential allergic reaction. Therefore, it's important to avoid administering clindamycin in such cases and seek an alternative antibiotic that does not have a similar chemical structure to penicillin to prevent an allergic reaction.
Choice C Reason:
Premeditating the client with epinephrine before administering the antibiotic is not a standard practice in this context. Epinephrine is used to treat severe allergic reactions but is not used as a preventive measure before administering antibiotics.
Choice D Reason:
Administering the clindamycin using a desensitization schedule might be an option in certain situations under the guidance of an allergist or immunologist, but it's not typically performed by nurses and requires a specific protocol and expertise in managing drug allergies. Obtaining an alternative antibiotic is a more appropriate and immediate action to avoid the risk of an allergic reaction in this scenario.