The healthcare provider prescribes enoxaparin sodium 80 mg SUBQ twice daily. The nurse is preparing a preloaded 1 mL syringe labeled, "enox“parin sodium injection, USP 60 mg/0.6 mL. How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

A) Asking the client to describe how she takes the medication is the most appropriate initial response by the nurse. “Heartburn” reported after taking risedronate raises concerns about potential esophageal irritation or gastroesophageal reflux disease (GERD) exacerbation. Understanding the client’s administration technique (e.g., whether she takes the medication with a full glass of water and remains upright for at least 30 minutes afterward) can help identify potential causes of the reported symptoms.

B) While suggesting the use of an antacid two hours after the medication may provide symptomatic relief, it does not address the underlying issue of potential esophageal irritation or GERD exacerbation related to risedronate administration. Moreover, if the client’s symptoms are due to esophageal irritation, using an antacid may mask the symptoms without addressing the cause.

C) Reminding the client to take the medication with plenty of water is a standard recommendation for bisphosphonate administration to minimize the risk of esophageal irritation and ensure proper drug absorption. However, since the client is already experiencing “heartburn,” further assessment of the client’s medication administration technique is warranted before providing this reminder.

D) Advising the client to go to the nearest emergency department is not appropriate at this stage, as the reported symptom of “heartburn” does not suggest an immediate life-threatening emergency. However, if the client experiences severe chest pain, difficulty swallowing, or signs of a severe allergic reaction (e.g., swelling of the face or throat, difficulty breathing), emergency medical attention would be necessary.

Therefore, the nurse should first assess the client’s medication administration technique to determine if improper administration may be contributing to the reported symptoms. Based on this assessment, appropriate interventions can be provided to address potential esophageal irritation or GERD exacerbation.

A) Hold the dose and notify the pharmacy to stop dispensing the next premixed doses: This action may prevent further administration of fluconazole, but it does not address the underlying concern of rising liver enzyme levels. Holding the dose and notifying the healthcare provider directly would be more appropriate.

B) Hold the dose and notify the healthcare provider of the changes in the laboratory studies: This is the correct response. RisIng liver enzyme levels, indIcated by an increasing trend in aspartate aminotransferase (AST), suggest potential liver dysfunction or damage, which can be a serious adverse effect of fluconazole. The nurse should hold the dose and promptly inform the healthcare provider for further evaluation and management.

C) Begin the infusion and monitor the client's bl’od urea nitrogen (BUN), serum creatinine, and liver function tests: Initiating the infusion without addressing the rising liver enzyme levels could potentially worsen liver function. It is essential to hold the dose and inform the healthcare provider before proceeding with further administration.

D) Begin the infusion and submit a drug reaction report to the nursing supervisor: While it's im’ortant to document adverse reactions and submit reports as appropriate, the priority in this situation is to hold the dose and notify the healthcare provider to address the rising liver enzyme levels.