The nurse reviews a new prasugrel prescription for a 78-year-old client who weighs 55 kg and has a history of transient ischemic attack. Which action is appropriate?
1Administer prasugrel and monitor for bruising because the previous transient ischemic attack is no longer relevant.
2Reduce the maintenance dose independently and administer it because low body weight is the only concern.
3Hold prasugrel and contact the prescriber because any prior transient ischemic attack is a contraindication.✓ Correct answer
4Administer prasugrel with an anticoagulant to offset the increased ischemic risk caused by older age.
Explanation
Prasugrel is contraindicated in clients with any history of transient ischemic attack or stroke because of net harm and intracranial bleeding risk. Age 75 years or older and body weight below 60 kg further increase bleeding risk. The nurse should hold the drug and clarify the prescription rather than administer it, independently change the dose, or add another antithrombotic drug.
Clinical reasoning Prior transient ischemic attack or stroke is an absolute prasugrel contraindication. Advanced age and low body weight add separate bleeding-risk warnings but do not remove that contraindication.
Decision rule A past transient ischemic attack means do not give prasugrel. Hold the medication, notify the prescriber, and obtain an alternative antiplatelet plan before administration.