A nurse is caring for a client who has been taking warfarin and has a prothrombin time of 30 seconds and an INR of 7. Which of the following medications should the nurse anticipate the provider to prescribe?

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.

A. If he misses a dose, he should double the dose at the next scheduled time: This statement is incorrect. Doubling the dose of warfarin after missing a dose can significantly increase the risk of bleeding due to excessive anticoagulation. The nurse should emphasize the importance of taking the medication as prescribed and what to do if a dose is missed, such as contacting the healthcare provider for guidance.

B. The client should use an electric razor while on this medication: This statement is correct. Warfarin is an anticoagulant medication that can increase the risk of bleeding. Therefore, it's essential for patients taking warfarin to avoid activities that may increase the risk of injury or bleeding, such as shaving with a traditional razor that can cause cuts or nicks. Using an electric razor reduces this risk.

C. Mild nosebleeds are common during initial treatment: This statement is not entirely accurate. While warfarin can increase the risk of bleeding, including nosebleeds, it's not necessarily common during the initial treatment phase. However, patients should be aware of signs of bleeding and report them to their healthcare provider promptly.

D. Warfarin increases the risk for deep vein thrombosis: This statement is incorrect. Warfarin is actually prescribed to reduce the risk of blood clots, including deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke, in patients who are at risk for these conditions. It works by inhibiting the formation of blood clots. Therefore, it does not increase the risk of DVT; rather, it decreases it.