A nurse is caring for a patient who has been prescribed apixaban (Eliquis) for deep vein thrombosis (DVT). Which instructions should be included in patient teaching? Select all that apply.

“Avoid activities that may cause injury.”

“Take medication with food.”

“Report signs and symptoms of bleeding immediately.”

“Monitor vital signs regularly.”

“Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).”.

Answer and Explanation

Correct Answer : A,C,E

Apixaban (Eliquis) is a blood thinner that prevents blood clots from forming or growing larger.

It is used to treat or prevent deep vein thrombosis (DVT), a condition in which a blood clot forms in a vein deep in the body, usually in the legs.

It can also prevent pulmonary embolism (PE), a condition in which a blood clot breaks off and travels to the lungs, blocking blood flow and causing breathing problems.

Patients taking apixaban should follow these instructions:

• Avoid activities that may cause injury.

Apixaban can increase the risk of bleeding, so patients should be careful not to cut or bruise themselves.

They should use a soft toothbrush, an electric razor, and avoid contact sports or other activities that may cause bleeding. They should also wear a medical alert bracelet or carry an identification card that states they are taking apixaban.

• Report signs and symptoms of bleeding immediately. Patients should notify their doctor or seek emergency care if they have any signs of bleeding, such as unusual bruising, red or black stools, blood in the urine, coughing up blood, vomiting blood, nosebleeds, heavy menstrual bleeding, headaches, dizziness, weakness, or swelling.

• Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).

These drugs can also increase the risk of bleeding and interfere with the effects of apixaban.

Patients should avoid taking aspirin, ibuprofen, naproxen, or other NSAIDs unless prescribed by their doctor. They should also check the labels of any over-the-counter medications or supplements they use and avoid those that contain aspirin or NSAIDs.

Choice B and D are wrong because:

• Take medication with food. Apixaban can be taken with or without food. Taking it with food does not affect its absorption or efficacy.

Therefore, this instruction is not necessary for patients taking apixaban.

• Monitor vital signs regularly. Apixaban does not affect blood pressure, heart rate, or oxygen saturation.

Therefore, monitoring vital signs regularly is not required for patients taking apixaban. However, patients should still follow their doctor’s advice on how often to check their blood tests, such as hemoglobin, hematocrit, and platelets.

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Correct Answer is ["A","C"]

Explanation

Heparin is an anticoagulant that inhibits blood clotting and prevents harmful clots from forming in blood vessels.However, heparin can also cause some serious side effects, such as bleeding, bruising, low platelet count, allergic reactions, and osteoporosis.

Therefore, patients who are at a high risk for developing these adverse effects should be monitored closely and have their heparin dose adjusted accordingly.

Choice A is correct because a patient who is post-op day 1 from brain surgery has a high risk of bleeding from the surgical site or intracranially.Heparin can increase this risk and cause life-threatening hemorrhage.

Therefore, this patient should not receive heparin unless absolutely necessary and under strict supervision.

Choice B is wrong because a patient with a pulmonary embolism (PE) is a candidate for heparin therapy.

A PE is a blood clot that blocks the blood flow to the lungs and can cause respiratory failure and death.Heparin can prevent the clot from becoming larger and causing more damage, and also prevent new clots from forming.

Therefore, this patient would benefit from heparin therapy and is not at a high risk of adverse effects.

Choice C is correct because a patient with active peptic ulcer disease (PUD) has a high risk of bleeding from the stomach or duodenum.

PUD is a condition where the lining of the digestive tract is eroded by stomach acid and bacteria.Heparin can worsen this condition and cause ulcer bleeding or perforation.

Therefore, this patient should avoid heparin therapy unless absolutely necessary and under strict supervision.

Choice D is wrong because a patient with uncontrolled atrial fibrillation (AF) is a candidate for heparin therapy.

AF is an irregular heartbeat that can cause blood clots to form in the heart chambers and travel to other organs, such as the brain or lungs.Heparin can prevent these clots from forming and reduce the risk of stroke or PE.

Therefore, this patient would benefit from heparin therapy and is not at a high risk of adverse effects.

Normal ranges of heparin depend on the type of heparin used (unfractionated heparin or low molecular weight heparin), the method of administration (intravenous or subcutaneous), and the indication for use (prophylaxis or treatment).Generally, the therapeutic range for heparin level is 0.3 - 0.7 U/mL, measured by anti-Xa assay.However, this range may vary depending on the pregnancy stage and the type of heparin used.The dose of heparin should be individualized according to the results of suitable laboratory tests and clinical response.

A. Ibuprofen B. Naproxen C. Acetaminophen D. Aspirin.

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.

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A nurse is caring for a patient who has been prescribed apixaban (Eliquis) for deep vein thrombosis (DVT). Which instructions should be included in patient teaching? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all that apply:

Correct Answer is ["A","C"]

Explanation

A patient who has atrial fibrillation is taking warfarin and has an INR of 2.5.The patient reports having frequent headaches and asks for an over-the-counter pain reliever.The nurse will recommend which medication?

Correct Answer is C

Explanation

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