The nurse administers intravaginal miconazole (Monistat) to a ...

[james]

The nurse administers intravaginal miconazole (Monistat) to a female patient with a vaginal candidiasis infection and a history of recent DVT, for which the patient takes warfarin (Coumadin).
 
  For which adverse effect should the nurse monitor the patient?
  a. Hyperkalemia
  b. Increase in WBCs
  c. Bruising and bleeding gums
  d. Increased vaginal itching and burning

Question 2

The nurse is caring for a 70-year-old patient taking clopidogrel (Plavix) 75 mg daily. What concerns should the nurse have regarding clopidogrel and the elderly?
 
  a. The dose should be the same for all adults regardless of age.
  b. The dose ordered should be 50 of that for a younger patient.
  c. The dose should be decreased by 25 in elderly patients with renal impairment.
  d. The daily maintenance dose of clopidogrel for an elderly patient is 25 mg.

[matt]

Answer to Question 1

ANS: C
Intravaginal miconazole can intensify the anticoagulant effects of warfarin; it can inhibit the metabolism of warfarin, causing levels to rise. Anticoagulation must be monitored closely, and warfarin doses may need to be reduced. The patient should be assessed for bleeding tendencies, such as bruising and bleeding gums.
Hyperkalemia would not occur as a result of concomitant use of warfarin and miconazole.
An increase in WBCs would not occur as a result of concomitant use of warfarin and miconazole.
An increase in vaginal itching and burning would not occur as a result of concomitant use of warfarin and miconazole. In fact, the itching and burning should be reduced with administration of intravaginal miconazole.

Answer to Question 2

ANS: A
The daily dose of clopidogrel for adults is 75 mg.
Dosage adjustments do not need to be made for elderly patients.
Dosage need not be changed for elderly patients with renal impairment.
The daily maintenance dose of clopidogrel for adults, regardless of age, is 75 mg once a day.

[james]

Excellent

[xiaomengxian]

TYSM