A nurse is caring for a client who is experiencing warfarin toxicity. Which of the following medications should the nurse administer?

A. Heart rate: The increase from 88/min to 110/min indicates tachycardia, which can be an early sign of hypovolemia, infection, or sepsis. When combined with hypotension and fever, this finding suggests possible postoperative complications requiring urgent evaluation.

B. Pedal pulses: Bilateral pedal pulses remain 2+, indicating adequate peripheral perfusion at this time. This finding is stable and does not suggest acute circulatory compromise requiring immediate follow-up.

C. Breath sounds: Breath sounds are clear and unchanged from admission, suggesting no current pulmonary complication such as atelectasis or pneumonia. This finding does not indicate an urgent problem.

D. Abdominal dressing: A sudden increase to a large amount of serosanguinous drainage after the client felt something “pop” raises concern for wound dehiscence or possible evisceration. This is a surgical emergency requiring immediate assessment and intervention.

E. Respiratory rate: The respiratory rate has increased from 18/min to 24/min, indicating tachypnea. This may reflect pain, infection, or developing sepsis and warrants prompt follow-up in the postoperative client.

F. Oxygen saturation: Oxygen saturation remains within an acceptable range at 95% on room air. Although it should continue to be monitored, it does not currently indicate acute respiratory compromise.

A. Cimetidine: Cimetidine is an H2-receptor antagonist used for gastric acid reduction. It does not significantly increase the risk of bleeding when taken with enoxaparin and is generally considered safe for concurrent use.

B. Docusate: Docusate is a stool softener and does not affect coagulation. It is safe to use with enoxaparin and can help prevent constipation associated with reduced mobility or opioid use.

C. Calcium supplement: Calcium supplements do not impact anticoagulation or platelet function. They are safe to take with enoxaparin and do not increase bleeding risk.

D. Naproxen: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet function and can increase the risk of bleeding when taken with enoxaparin. Clients should avoid NSAIDs unless approved by the provider and use alternative pain management strategies.