After receiving the third dose of a new oral anticoagulant prescription, an older client develops bleeding and tender gums and has many new bruises. Which action(s) should the nurse implement? Select all that apply.

Obtain a soft bristle toothbrush for client.

Provide a PRN nonsteroidal anti-inflammatory (NSAID) for gum discomfort.

Review most recent coagulation lab values.

Report findings to healthcare provider.

Complete a medication variance report.

Answer and Explanation

Correct Answer : A,C,D

A) Obtain a soft bristle toothbrush for the client:
This is an appropriate action because bleeding and tender gums can indicate oral bleeding, which may be exacerbated by the use of a standard toothbrush. Switching to a soft bristle toothbrush can help minimize trauma to the gums and reduce bleeding.

B) Provide a PRN nonsteroidal anti-inflammatory drug (NSAID) for gum discomfort:
Administering NSAIDs in this situation is not recommended. NSAIDs can further increase the risk of bleeding due to their antiplatelet effects. Therefore, providing an NSAID could exacerbate the client’s bleeding symptoms.

C) Review most recent coagulation lab values:
This is a crucial action to assess the client’s coagulation status and determine if the bleeding and bruising are related to anticoagulant therapy. Reviewing coagulation lab values, such as prothrombin time (PT) and international normalized ratio (INR), can provide important information about the client’s clotting function and guide further management.

D) Report findings to the healthcare provider:
This is essential to ensure timely evaluation and management of the client’s symptoms. Bleeding and bruising after anticoagulant therapy may indicate an increased risk of bleeding complications, and the healthcare provider needs to be informed promptly for further assessment and possible adjustment of the anticoagulant regimen.

E) Complete a medication variance report:
While documenting the client’s symptoms and actions taken is important for quality assurance and tracking adverse events, completing a medication variance report may not be the immediate priority in this situation. The focus should be on assessing the client’s condition, managing symptoms, and communicating with the healthcare provider for appropriate intervention

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Correct Answer is B

Explanation

A) Stop the oral contraceptive immediately:
This instruction is incorrect and potentially dangerous. Abruptly stopping oral contraceptives can lead to unintended pregnancy and disrupt the client's menstrual cycle. It's essential for the client to continue taking their oral contraceptive unless instructed otherwise by their healthcare provider.

B) Use an additional form of contraception:
This is the correct action. Erythromycin is an antibiotic that can reduce the effectiveness of oral contraceptives by altering the gut flora and potentially interfering with their absorption. Therefore, it is recommended to use an additional form of contraception, such as condoms, while taking erythromycin to prevent unintended pregnancy.

C) Take the medications at least 12 hours apart:
While it's generally a good practice to space medications apart to avoid interactions, specific instructions regarding the timing of erythromycin and oral contraceptive administration should be obtained from the healthcare provider. Simply spacing the medications apart may not be sufficient to prevent contraceptive failure.

D) Avoid prolonged exposure to direct sunlight:
This instruction is unrelated to the interaction between erythromycin and oral contraceptives. Erythromycin can increase sensitivity to sunlight (photosensitivity), but this does not affect the effectiveness of oral contraceptives. Therefore, while it's important to advise clients to protect themselves from sun exposure while taking erythromycin, it's not directly related to contraceptive use.

Correct Answer is ["200"]

Explanation

The nurse should program the infusion pump to deliver 200 mL/hr.

Although the medication dosage is 400 mg, the infusion pump rate is determined by the total volume of the IV fluid (including the medication) and the desired infusion time.

In this case:

Total volume of IV bag (D,W): 200 mL

Infusion time: 1 hour

Since the medication is already diluted in the 200 mL bag, the entire volume needs to be delivered over the course of the hour. Therefore, the nurse should program the pump to deliver the full 200 mL of the solution at a rate of:

200 mL / 1 hour = 200 mL/hr

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After receiving the third dose of a new oral anticoagulant prescription, an older client develops bleeding and tender gums and has many new bruises. Which action(s) should the nurse implement? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Correct Answer is B

Explanation

A client receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5% in water (D,W) 200 mL. The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only.)

Correct Answer is ["200"]

Explanation

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