The nurse is reviewing the client's prescriptions.

Exhibits

The nurse is administering medications to the client and is monitoring potential adverse effects of medications

For each body system below, click to specify the assessment findings that could indicate a serious adverse reaction. Each body system may support more than 1 potential assessment finding. To deselect a finding click on the finding again.

Body system	Findings
Head, Eyes, Ears, Nose, and Throat (HEENT)	Yellowing of the eyes Blurred vision Dry eyes
Gastrointestinal	Abdominal pain Weight gain
Hematologic	Increased bruising Increased bleeding tendency Insomnia
Genitourinary	Darkening of the urine Urinary frequency

A. Docusate. Docusate is a stool softener that helps prevent constipation, which can be beneficial for clients taking enoxaparin, as straining during bowel movements can increase the risk of bleeding. It does not have anticoagulant properties and does not pose a significant risk of increased bleeding.
B. Cimetidine. Cimetidine, an H2-receptor antagonist used to reduce stomach acid, does not directly increase bleeding risk. However, long-term use can affect liver metabolism and interact with some anticoagulants, but it is not considered unsafe for routine use with enoxaparin.
C. Calcium supplement. Calcium supplements are commonly used for bone health and do not interfere with enoxaparin’s anticoagulant effects. They do not increase bleeding risk and are generally safe for clients taking anticoagulants.
D. Naproxen. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation and increases the risk of gastrointestinal bleeding. When combined with enoxaparin, which is a low-molecular-weight heparin, the risk of bleeding complications, including gastrointestinal and intracranial hemorrhage, significantly increases. Clients should be advised to use acetaminophen for pain relief instead of NSAIDs while taking enoxaparin.

Rationale:

• Opioid intoxication. The client was found unresponsive with a needle in the left antecubital space, suggesting recent intravenous drug use. The administration of naloxone, an opioid antagonist, further supports opioid intoxication as the likely condition. Additionally, the client presents with decreased level of consciousness, respiratory depression (respiratory rate of 10/min), and decreased bowel sounds, all of which are classic signs of opioid intoxication.
• Pupil characteristics
  The client’s pupils are miotic (constricted), which is a hallmark sign of opioid intoxication due to the drug’s effect on the parasympathetic nervous system. Opioids, particularly heroin and prescription narcotics, cause pinpoint pupils, which can help differentiate opioid intoxication from other conditions that may cause altered mental status.

Rationale for Incorrect Options:

• Opioid withdrawal is characterized by symptoms such as agitation, dilated pupils, diarrhea, and tachycardia, none of which are present in this client. Instead, the client exhibits signs of central nervous system depression rather than hyperactivity, making withdrawal unlikely.
• Hallucinogen intoxication typically presents with hallucinations, paranoia, agitation, and altered sensory perception. The client’s presentation does not include these findings, making hallucinogen intoxication an unlikely cause.
• Alcohol intoxication is associated with slurred speech, ataxia, and confusion, but the client’s history indicates only one beer was consumed, which is not enough to cause such profound central nervous system depression. The presence of a needle and response to naloxone further support opioid intoxication rather than alcohol intoxication.
• Alcohol withdrawal presents with symptoms such as tremors, tachycardia, hypertension, and agitation. The client is instead experiencing respiratory depression and sedation, which are inconsistent with alcohol withdrawal.