A nurse is caring for a client who is postoperative following hip arthroplasty. The nurse should anticipate which of the following medications for this client?

Choice A reason: Using an electric razor while on warfarin is the correct instruction. Warfarin is an anticoagulant that inhibits the formation of blood clots and prolongs the bleeding time. Using an electric razor can reduce the risk of cuts and bleeding while shaving. The client should avoid using sharp objects or instruments that can cause injury or trauma.

Choice B reason: Doubling the dose of warfarin if a dose is missed is not the correct instruction. This is a dangerous and potentially fatal advice, as it can cause overdose and severe bleeding. The client should take the missed dose as soon as possible, unless it is close to the next scheduled dose, in which case the client should skip the missed dose and resume the regular dosing schedule. The client should never take extra doses or change the dose without consulting the provider.

Choice C reason: Mild nosebleeds being common during initial treatment is not the correct instruction. This is a false and misleading statement, as nosebleeds are not a normal or expected side effect of warfarin therapy. Nosebleeds can indicate bleeding problems or complications, such as thrombocytopenia, which is a low platelet count. The client should report any nosebleeds or other signs of bleeding, such as bruising, petechiae, hematuria, or melena, to the provider immediately.

Choice D reason: Increasing fiber intake to reduce the adverse effect of constipation is not the correct instruction. This is an irrelevant and unnecessary recommendation, as constipation is not a common or serious adverse effect of warfarin therapy. Constipation can be caused by many factors, such as diet, hydration, activity, or medication. The client should maintain a balanced and consistent diet, drink plenty of fluids, and exercise regularly to prevent constipation. The client should also avoid foods that are high in vitamin K, such as green leafy vegetables, as they can interfere with the effect of warfarin.

Choice A reason: This is incorrect because aspirin is not a suitable medication for preventing venous thromboembolism (VTE) in a client who is postoperative following hip arthroplasty. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that has antiplatelet and analgesic effects, but it is not as effective as anticoagulants for VTE prophylaxis.

Choice B reason: This is incorrect because alteplase is not a medication for preventing VTE, but for treating it. Alteplase is a thrombolytic agent that dissolves existing blood clots by activating plasminogen. It is used for acute ischemic stroke, myocardial infarction, and massive pulmonary embolism, but it has a high risk of bleeding and is contraindicated in clients who have had recent surgery.

Choice C reason: This is incorrect because clopidogrel is not a medication for preventing VTE, but for preventing arterial thrombosis. Clopidogrel is an antiplatelet agent that inhibits the adenosine diphosphate (ADP) receptor on platelets, preventing their aggregation. It is used for clients who have had acute coronary syndrome, percutaneous coronary intervention, or ischemic stroke, but it is not effective for VTE prophylaxis.

Choice D reason: This is correct because enoxaparin is a medication for preventing VTE in a client who is postoperative following hip arthroplasty. Enoxaparin is a low molecular weight heparin (LMWH) that inhibits factor Xa and thrombin, preventing the formation of fibrin. It is administered subcutaneously once or twice daily and does not require routine laboratory monitoring. It has a lower risk of bleeding and heparin-induced thrombocytopenia (HIT) than unfractionated heparin.