The nurse plans to administer the adult client’s prescriptions which are metoprolol, hydrochlorothiazide, enoxaparin and atorvastatin.
The current laboratory values are; Serum potassium 5.2 mmol/L, Platelet Count 98,000/mm, Serum cholesterol 250 mg/dL and Serum Creatinine 1.2 mg/dL.
Which medication should the nurse hold and notify the prescriber?
A.
Metoprolol.
B.
Hydrochlorothiazide.
C.
Enoxaparin.
D.
Atorvastatin.
The correct answer and Explanation is :
The correct answer is C. Enoxaparin.
Explanation:
Enoxaparin is a low-molecular-weight heparin (LMWH) used to prevent blood clots, especially in patients at risk of deep vein thrombosis (DVT) or pulmonary embolism. However, one of the significant side effects of enoxaparin is thrombocytopenia (low platelet count), which can lead to increased bleeding risk.
The patient’s platelet count is 98,000/mm³, which is lower than the normal range of 150,000 to 400,000/mm³. Administering enoxaparin in a patient with thrombocytopenia can further decrease platelet levels, increasing the risk of bleeding. A platelet count below 100,000/mm³ is often considered a threshold at which the use of anticoagulants like enoxaparin should be carefully evaluated or stopped to prevent serious bleeding complications. Therefore, the nurse should hold enoxaparin and notify the prescriber due to this abnormal platelet count.
Other Medications:
- Metoprolol: This beta-blocker is used to manage hypertension and other cardiovascular conditions. There is no direct contraindication with the current lab values, as metoprolol does not significantly impact potassium levels, platelet counts, or creatinine.
- Hydrochlorothiazide: This is a diuretic often used to treat hypertension and edema. Although it can cause potassium loss, the patient’s serum potassium level is 5.2 mmol/L, which is slightly elevated but not critically high. It is important to monitor potassium, but it doesn’t warrant holding the medication in this case.
- Atorvastatin: This statin is used to lower cholesterol levels, and the patient’s serum cholesterol is 250 mg/dL, which is elevated. There is no contraindication related to platelet count or creatinine levels, and statins are generally safe unless severe liver dysfunction is present.
Thus, enoxaparin should be held due to the risk of bleeding from thrombocytopenia.