A nurse is teaching a client about a new prescription for clopidogrel. Which of the following instructions should the nurse include?
You might have to stop taking this medication five days before a dental procedure
You will need routine monitoring of your platelet levels while taking this medication
Expect to have very dark colored stools while taking this medication
Stop this medication immediately if you experience stomach upset or reflux
The Correct Answer is A
Choice A reason: Clopidogrel is an anti-platelet agent that irreversibly inhibits the P2Y12 ADP receptor on platelets. This significantly increases the risk of prolonged bleeding. Due to this pharmacologic action, it is standard practice to hold this medication for approximately 5 to 7 days before surgical or invasive dental procedures to allow for the replacement of circulating platelets.
Choice B reason: Unlike heparin or warfarin, clopidogrel does not require routine laboratory monitoring of platelet counts or coagulation studies such as international normalized ratio or partial thromboplastin time. While monitoring for signs of bleeding is critical, regular lab checks are not standard for this specific medication, making this instruction incorrect.
Choice C reason: Dark, tarry stools (melena) are a clinical manifestation of upper gastrointestinal bleeding. Because clopidogrel significantly inhibits platelet function, this is a serious adverse effect, not an expected finding. The client must be educated to report such findings immediately as it indicates significant internal bleeding requiring medical intervention.
Choice D reason: Mild gastrointestinal upset can be a side effect, but the client should not discontinue the medication abruptly without consulting their healthcare provider. Abrupt cessation of anti-platelet therapy in a patient with a history of cardiac issues or stent placement significantly increases the risk of a life-threatening thrombotic event.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Cardiac enzymes, such as cardiac troponin I and T, are structural proteins released into the bloodstream when myocardial cells are damaged or undergo necrosis. The serum levels of these markers correlate with the extent of myocardial injury, allowing clinicians to quantify the severity of the infarct.
Choice B reason: Cardiac enzymes confirm the presence and severity of myocardial injury but do not provide anatomical information regarding the location of the infarction. Imaging studies, such as an electrocardiogram or a cardiac magnetic resonance imaging, are required to determine which coronary artery is occluded and where the myocardial damage is localized.
Choice C reason: Cardiac enzymes are specific markers for myocardial cell death and do not indicate pulmonary congestion. Pulmonary congestion is typically assessed through physical examination findings, such as auscultation of crackles, assessment of respiratory status, and radiographic findings like a chest X-ray, rather than through blood-based biomarker analysis.
Choice D reason: Cardiac enzymes do not provide structural data about heart valves or overall heart geometry. Echocardiography is the gold-standard diagnostic tool used to visualize the structure of the heart, assess valve function, evaluate wall motion abnormalities, and measure the ejection fraction of the left ventricle in post-infarction patients.
Correct Answer is C
Explanation
Choice A reason: Reducing the rate of the transfusion is inappropriate when a febrile or allergic reaction is suspected. Continuing to administer blood, even at a slower rate, allows more antigenic material to enter the systemic circulation, which could exacerbate the immune-mediated reaction and lead to severe, life-threatening anaphylaxis or septic shock.
Choice B reason: Calling for assistance is a reasonable step, but slowing the rate to keep the vein open is contraindicated. The primary objective is to immediately cease exposure to the causative agent. Keeping the line open with the current blood tubing would still permit residual blood products to enter the circulation.
Choice C reason: This is the correct priority action. When a client exhibits signs of a transfusion reaction, such as pyrexia and pruritus, the infusion must be halted immediately to prevent further adverse effects. Replacing the blood tubing with a new set and flushing with 0.9% normal saline maintains venous access for emergency intervention.
Choice D reason: While diphenhydramine is often used to manage mild allergic reactions, providing reassurance and medication before stopping the transfusion is negligent. The nurse must prioritize patient safety by eliminating the source of the potential transfusion-related acute lung injury or hemolytic reaction before initiating any pharmacologic symptom management.
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