Rosuvastatin can cause muscle injury, and the severe skeletal muscle reaction to watch for is rhabdomyolysis. This condition involves breakdown of muscle tissue releasing substances like myoglobin into the bloodstream, which can damage the kidneys and lead to kidney failure. Nurses should be alert for new or worsening muscle pain, tenderness, or weakness, especially if it’s accompanied by dark or cola-colored urine. If rhabdomyolysis is suspected, the statin should be held and creatine kinase levels checked promptly; aggressive hydration is often needed to protect the kidneys. Risk factors include high-dose therapy, drug interactions (such as with fibrates or certain antibiotics), older age, renal or hepatic impairment, and hypothyroidism. Educate the patient to report muscle symptoms right away and to stay well-hydrated. The other conditions listed—myasthenia gravis, dyskinesia, and agranulocytosis—are not typical adverse effects of statins.

Bleeding risk with antiplatelet therapy is what this item emphasizes. Clopidogrel blocks the P2Y12 ADP receptor on platelets, preventing platelet aggregation. When it’s used with aspirin, two drugs that impair platelet function, the chance of unexpected or prolonged bleeding increases. That’s why patient teaching should highlight signs of bleeding (easy bruising, gum or nosebleeds, blood in stool or urine) and the importance of avoiding or limiting other bleeding-promoting medications unless directed by a clinician. It’s also useful to know the usual dosing context: the common maintenance dose is 75 mg daily, so a 25 mg daily dose is not standard. Constipation or SAMPLEhypotension are not typical concerns with clopidogrel therapy.

Oral versus injectable anticoagulants. Warfarin is the anticoagulant given by mouth. It works by inhibiting vitamin K-dependent production of clotting factors II, VII, IX, and X, which makes it suitable for long-term oral anticoagulation. Because warfarin takes several days to reach full effect, patients are often bridged with a parenteral anticoagulant until the INR is in the therapeutic range. The other agents listed are not oral: enoxaparin is given by subcutaneous injection; bivalirudin and lepirudin are direct thrombin inhibitors administered intravenously. So, when switching from an injectable anticoagulant to an oral one, warfarin is the correct oral option.

Mannitol is an osmotic diuretic that works only if the kidneys can filter and excrete it. It increases the osmolarity of the filtrate, pulling water into the renal tubules to be eliminated. Because of this dependency on urine production, it must be used when there is some level of renal function. In an anuric patient, there is no urine output, so mannitol cannot be excreted. It then stays in the bloodstream, raising plasma osmolality and shifting fluids in ways that can lead to volume overload, edema (including pulmonary edema), electrolyte disturbances, and potential worsened overall volume status. For that reason, mannitol should be avoided in anuric patients. Head injury is a common indication for mannitol to reduce intracranial pressure, so it’s appropriate there. In diabetes mellitus, the drug can still be used with caution, though it requires monitoring for fluid and electrolyte balance. In cisplatin chemotherapy, mannitol is sometimes used to promote diuresis and mitigate nephrotoxicity, so it isn’t contraindicated.