The healthcare provider prescribes clopidogrel (Plavix) for a patient at risk for a myocardial infarction. While instructing the patient about the adverse effects and precautions associated with this drug, the nurse tells him that the following drugs should not be used while on clopidogrel unless the doctor is consulted. (Select all that apply.)

A. Clotting at the incision site. Enoxaparin (Lovenox) is an anticoagulant medication used to prevent blood clots, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE), which are common complications following orthopedic surgeries like knee replacement. Monitoring for clotting at the incision site is essential to ensure that the medication is effectively preventing excessive clot formation while also ensuring that the patient does not experience excessive bleeding.

B. Increased pain. While increased pain could be a concern postoperatively, particularly after a surgical procedure like knee replacement, it is not a specific monitoring parameter for enoxaparin administration. Pain management is typically addressed separately, and increased pain may indicate issues such as inadequate analgesia, surgical complications, or other factors unrelated to enoxaparin therapy.

C. Gingival hyperplasia. Gingival hyperplasia refers to an overgrowth of gum tissue and is not directly associated with enoxaparin therapy. This side effect is more commonly associated with certain medications such as phenytoin and cyclosporine rather than anticoagulants like enoxaparin. Monitoring for gingival hyperplasia would not be relevant in this context.

D. Signs and symptoms of bruising and bleeding. This is the correct answer. Enoxaparin is an anticoagulant medication, which increases the risk of bleeding. Therefore, monitoring for signs and symptoms of bruising and bleeding is crucial to detect any potential complications such as hemorrhage or hematoma formation. This includes assessing for unusual bruising, bleeding from the gums, nosebleeds, hematuria, melena, or any other signs of internal or external bleeding. Prompt recognition and management of bleeding complications are essential to ensure patient safety during enoxaparin therapy, especially following orthopedic surgery.

To find the volume of amoxicillin solution the nurse needs to administer, we can divide the desired dose (300 mg) by the concentration of the solution (250 mg/5 mL).

Here's the calculation:

Amoxicillin volume (mL) = Desired dose (mg) / Concentration (mg/mL) Amoxicillin volume (mL) = 300 mg / 250 mg/5 mL

Since we're dividing by a fraction, it's mathematically equivalent to multiply by the reciprocal of the fraction. The reciprocal of 250 mg/5 mL is 5 mL/250 mg.

Amoxicillin volume (mL) = 300 mg * (5 mL / 250 mg)

Cancel out the milligrams (mg) units:

Amoxicillin volume (mL) = 300 mg / 250 mg * 5 mL

Amoxicillin volume (mL) = 1.2 mL (rounded to one decimal place)

However, since we are dealing with medication, it's best to round to the nearest whole number for accuracy in administering the dose.

Therefore, the nurse should administer 6.0 mL of amoxicillin oral solution.