A nurse is caring for a client who has deep vein thrombosis and is receiving enoxaparin therapy subcutaneously once daily at home. The nurse should instruct the client to report which of the following findings immediately?
Bruising at injection site
Redness at injection site
Swelling in one leg
Mild pain at injection site.
The Correct Answer is C
This is because swelling in one leg could indicate a new or worsening deep vein thrombosis (DVT), which is a serious condition that can lead to pulmonary embolism or other complications. The client should report this finding to the provider immediately and seek medical attention.
Choice A) Bruising at injection site is wrong because bruising is a common and expected side effect of enoxaparin therapy, especially if the client is using the same injection site repeatedly.
The client should be instructed to rotate the injection sites and apply gentle pressure after each injection to minimize bruising.
Choice B) Redness at injection site is wrong because redness is also a common and expected side effect of enoxaparin therapy, as it indicates a local inflammatory response to the medication.
The client should be advised to avoid rubbing or scratching the injection site and to apply a cold compress if needed.
Choice D) Mild pain at injection site is wrong because mild pain is also a common and expected side effect of enoxaparin therapy, as it reflects the needle insertion and the medication delivery.
The client should be reassured that the pain will subside shortly and to use a different injection site for the next dose.
Normal ranges for enoxaparin therapy are based on the client’s weight, indication, and renal function.
The usual dose for DVT prophylaxis is 40 mg subcutaneously once daily, and the usual dose for DVT treatment is 1 mg/kg subcutaneously every 12 hours.
The client should have regular blood tests to monitor the anti-factor Xa level, which should be between 0.5 and 1.0 IU/mL for DVT prophylaxis and between 0.6 and 1.0 IU/mL for DVT treatment.
The client should also have regular platelet counts to check for heparin-induced thrombocytopenia (HIT), which is a rare but serious complication of enoxaparin therapy that causes a drop in platelets and an increased risk of thrombosis.
The normal platelet count range is 150,000 to 450,000/mm3.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The patient reports having frequent headaches and asks for an over-the-counter pain reliever.The nurse will recommend acetaminophen, which is the safest pain reliever while taking warfarin.Acetaminophen does not interfere with the anticoagulant effect of warfarin and does not increase the risk of bleeding.
Choice A is wrong because ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can enhance the anticoagulant effect of warfarin and increase the likelihood of harmful bleeding.
NSAIDs can also cause stomach ulcers, kidney damage, and high blood pressure.
Choice B is wrong because naproxen is another NSAID that has the same risks as ibuprofen.
Naproxen should be avoided by patients taking warfarin.
Choice D is wrong because aspirin is also an anticoagulant that can increase the risk of bleeding when taken with warfarin.
Aspirin can also cause stomach irritation, ulcers, and allergic reactions.
The normal range for INR is 2 to 3 for patients with atrial fibrillation who are taking warfarin.
An INR of 2.5 indicates that the patient’s blood is taking longer to clot than normal, but not too long.
The patient should have regular blood tests to monitor their INR and adjust their warfarin dose if needed.
Correct Answer is C
Explanation
Activated partial thromboplastin time (aPTT).
Dabigatran (Pradaxa) is a direct oral anticoagulant (DOAC) that inhibits thrombin, a key enzyme in the coagulation cascade.
Dabigatran prolongs the aPTT, which is a measure of the intrinsic and common pathways of coagulation.The aPTT can be used to monitor the anticoagulant effect of dabigatran, although routine monitoring is not required.
Choice A) Prothrombin time (PT) is wrong because PT measures the extrinsic and common pathways of coagulation, which are not affected by dabigatran.
PT is used to monitor warfarin therapy, not dabigatran.
Choice B) International normalized ratio (INR) is wrong because INR is a standardized version of PT that is used to monitor warfarin therapy, not dabigatran.
INR is not affected by dabigatran.
Choice D) Platelet count is wrong because platelet count is a measure of the number of platelets in the blood, which are involved in primary hemostasis.
Platelet count is not affected by dabigatran, which acts on secondary hemostasis.
Normal ranges for these tests are:
• aPTT: 25 to 35 seconds
• PT: 11 to 13.5 seconds
• INR: 0.8 to 1.2
• Platelet count: 150,000 to 450,000 per microliter of blood
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