A nurse is collecting data from a client who is receiving clopidogrel following the placement of a cardiac stent. Which of the following findings should the nurse identify as an adverse effect of this medication?

Essential

1. "Avoid taking other medications that can cause bleeding, such as NSAIDs like ibuprofen." Both aspirin and clopidogrel increase the risk of bleeding. NSAIDs like ibuprofen can further increase this risk, so it is crucial to avoid them unless advised otherwise by a healthcare provider.

2. "Continue to take your newly prescribed medications until your prescriber tells you not to do so." Discontinuing aspirin and clopidogrel without medical advice can increase the risk of stent thrombosis and other complications. It is essential to follow the prescribed regimen strictly.

3. “Report any unexpected bleeding to your primary health provider." Monitoring for signs of bleeding (such as bruising, blood in the stool or urine, or unusual bleeding) is important due to the increased bleeding risk associated with these medications. Prompt reporting can help manage and mitigate serious complications.

Unrelated

1. "Drink a glass of water after each dose of your new drug." While staying hydrated is generally good advice, it is not specifically relevant to the efficacy or safety of aspirin and clopidogrel.

2. "Follow up with the prescribed laboratory testing needed to monitor your clotting values." Routine clotting tests (such as INR, PT, or aPTT) are not typically required for monitoring the effects of aspirin and clopidogrel, as these medications do not usually require lab monitoring like warfarin does.

3. "Eat foods high in Vitamin K and calcium to help prevent clotting." This advice is unrelated because Vitamin K can counteract the effects of anticoagulants like warfarin but does not affect the action of antiplatelet drugs like aspirin and clopidogrel. Calcium intake is also unrelated to the management of these medications.

A. Labeling is not always reliable and herbal products should be used with caution. Herbal products are not subject to the same rigorous regulations and testing as pharmaceutical drugs. Therefore, their labeling may not always be accurate or comprehensive. Patients need to be aware of potential risks, interactions, and variations in potency associated with herbal products. Education helps patients make informed decisions and use these products safely.

B. Herbal products are approved under strict FDA regulations. This statement is false. Unlike pharmaceutical drugs, herbal products are regulated as dietary supplements in the United States and are not subject to the same level of scrutiny and approval processes by the FDA. While the FDA regulates the manufacturing and labeling of dietary supplements, including herbal products, the standards are not as strict as those for prescription or over-the-counter medications.

C. There are so few side effects, and they can be purchased without a prescription. This statement is misleading and potentially dangerous. Herbal products can indeed have side effects and interactions with medications, and their safety profiles vary widely. Additionally, the availability of herbal products without a prescription does not necessarily imply safety. Patients need education to understand potential risks and benefits associated with herbal product use.

D. The manufacturer has repeatedly demonstrated effectiveness. This statement is unsubstantiated and may not be true for all herbal products. Unlike pharmaceutical drugs, herbal products often lack extensive scientific evidence supporting their effectiveness for specific indications. While some manufacturers may conduct studies to support their products' efficacy, the evidence may be limited or inconclusive. Patients need education to critically evaluate claims of effectiveness and make informed decisions about herbal product use.