A nurse is caring for a client who has a respiratory infection and is receiving an antibiotic. Which of the following medications puts the client at risk for developing hearing loss?

Atorvastatin is an HMG-CoA reductase inhibitorthat lowers cholesterol by blocking the rate-limiting step of hepatic cholesterol synthesis. Its primary therapeutic goal is the reduction of atherogenic lipoproteinsto prevent cardiovascular disease and stroke. Effective therapy is measured by a significant improvement in the lipid profile, specifically targeting the reduction of low-density lipoproteins(LDL).

Rationale:

A.Decreased HDL levels would indicate a worsening of the patient's cardiovascular risk profile rather than effective treatment. High-density lipoprotein (HDL) is considered "good" cholesterol because it helps remove other forms of cholesterol from the bloodstream. A successful response to statin therapy would involve maintaining or slightly increasing HDL levels to provide better cardioprotective benefits.

B.Increased serum transaminase levels are an adverse effect of atorvastatin indicating potential hepatotoxicity, not therapeutic effectiveness. Statins are metabolized by the liver and can occasionally cause inflammation or damage to hepatocytes. If these enzymes (AST and ALT) rise significantly, the nurse must report this finding as it may necessitate the discontinuation of the medication.

C.Decreased LDL levels are the hallmark indicator of effective atorvastatin therapy. Low-density lipoprotein is the primary target for statins because it contributes to plaque buildup in the arteries, leading to atherosclerosis. A significant reduction in LDL proves that the HMG-CoA reductase inhibitor is successfully lowering the production of harmful cholesterol and reducing overall cardiovascular risk.

D.Increased creatine kinase (CK) levels are a laboratory marker for muscle damage and a sign of a serious adverse effect called rhabdomyolysis. This condition involves the breakdown of skeletal muscle fibers, which can lead to acute renal failure. Elevated CK levels are a reason for concern and immediate clinical intervention, not a sign that the cholesterol-lowering treatment is working.

Enoxaparin is a low-molecular-weight heparin(LMWH) that exerts anticoagulant effects by accelerating the activity of antithrombin III, primarily inhibiting factor Xa. It is used for the prophylaxis and treatment of deep vein thrombosisand pulmonary embolism. Unlike unfractionated heparin, it has a more predictable pharmacological profile and typically does not require routine laboratory monitoring of clotting times.

Rationale:

A.Diarrhea is not a common or expected side effect of enoxaparin therapy, as the drug does not significantly affect the gastrointestinal microbiome. The most concerning side effects are related to bleeding or heparin-induced thrombocytopenia. If a patient experiences diarrhea, the nurse should investigate other causes such as dietary changes, infections, or different medications.

B.Monitoring the skin for bruising is a vital safety instruction because enoxaparin increases the risk of bleeding and hemorrhage. Bruising or ecchymosis can indicate that the medication is excessively thinning the blood or that the patient has experienced minor trauma. Early detection of bleeding allows for prompt medical intervention to adjust the dosage or manage complications.

C.Enoxaparin must be injected into the subcutaneous tissue, typically in the abdomen, and should never be injected into a muscle. Intramuscular injection of anticoagulants can cause the formation of painful and dangerous hematomas due to the high vascularity of muscle tissue. The nurse must ensure the client understands the correct technique for deep subcutaneous administration.

D.Weekly INR checks are required for patients taking warfarin, but they are not necessary for those on enoxaparin. Enoxaparin provides a very stable and predictable anticoagulant response that does not require the frequent dose adjustments associated with Vitamin K antagonists. This lack of required blood work is one of the primary benefits of LMWH therapy.