The healthcare provider prescribes enoxaparin sodium 80 mg SUBQ three times daily. The nurse is preparing a preloaded 1 mL syringe labeled “Enoxaparin sodium injection, USP 60 mg/0.6 mL.”

How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

Choice A reason: Giving the next scheduled dose without further assessment is not advisable. An INR of 2.8 is within the therapeutic range for many conditions treated with warfarin, but it is important to ensure that the INR is stable and not trending higher, which could increase the risk of bleeding.

Choice B reason: Obtaining another blood sample might be necessary if there is suspicion of an error or if the INR is unexpectedly high or low. However, in this scenario, the INR is within the therapeutic range, so this action is not immediately necessary.

Choice C reason: Monitoring for signs of bleeding is always important for clients on warfarin, but it does not address the immediate need to communicate with the healthcare provider about the current INR level and any potential adjustments to the medication.

Choice D reason: Notifying the healthcare provider is the most appropriate action. The healthcare provider needs to be aware of the current INR level to make any necessary adjustments to the warfarin dosage and to provide further instructions on monitoring and follow-up.

Choice A Reason

Morphine, an opioid analgesic, is commonly prescribed for severe pain management, such as in cases of metastatic cancer. One of the well-known side effects of morphine is constipation. This occurs because opioids slow down gastrointestinal motility, leading to harder and less frequent stools. Therefore, it is crucial for patients taking morphine to monitor their bowel movements and use stool softeners or laxatives as needed to prevent constipation. This choice indicates that the client understands the importance of managing this common side effect, which can significantly impact their comfort and quality of life.

Choice B Reason

Grapefruit juice is known to interact with various medications by inhibiting the cytochrome P450 3A4 (CYP3A4) enzyme in the liver, which can lead to increased blood levels of certain drugs. However, morphine is primarily metabolized by the liver enzyme UGT2B7, not CYP3A4. Therefore, grapefruit juice does not significantly affect morphine metabolism. This choice reflects a misunderstanding of the specific interactions relevant to morphine.

Choice C Reason

Taking a benzodiazepine at the same time as morphine can be dangerous due to the risk of additive central nervous system (CNS) depression. Both morphine and benzodiazepines can cause sedation, respiratory depression, and impaired cognitive and motor functions. Concurrent use increases the risk of severe side effects, including potentially life-threatening respiratory depression. This choice indicates a lack of understanding of the risks associated with combining these medications.

Choice D Reason

While it is important to monitor for signs of agitation and insomnia, these are not the primary concerns associated with morphine use. Morphine is more likely to cause sedation rather than agitation, and insomnia is not a common side effect. This choice does not reflect a comprehensive understanding of the primary side effects and necessary precautions related to morphine use.