A patient with type 2 diabetes is taking Ozempic (a GLP-1 receptor agonist) and is scheduled for elective surgery.
Which preoperative teaching should the nurse provide regarding the medication?

This question assesses knowledge of coagulation monitoring for vitamin K antagonists. It requires identifying the correct laboratory markers used to titrate warfarin, which is essential to achieve a therapeutic anticoagulant effect while minimizing the risk of life-threatening bleeding complications in clinical practice.

Choice A rationale

The aPTT is used to monitor the therapeutic effect of intravenous heparin therapy, which acts through the intrinsic coagulation pathway. It is not an appropriate laboratory test for monitoring the effects of warfarin, which acts on the extrinsic pathway.

Choice B rationale

While platelet levels are monitored in patients on anticoagulants to detect heparin-induced thrombocytopenia, they are not the diagnostic marker used to titrate warfarin doses. Warfarin does not significantly impact platelet counts in a way that requires dosage adjustment.

Choice C rationale

Warfarin therapy is monitored using the Prothrombin Time (PT) and the International Normalized Ratio (INR). These tests measure the time it takes for blood to clot via the extrinsic pathway, allowing for precise dosage adjustments to maintain therapeutic anticoagulation.

Choice D rationale

Red blood cell counts are used to monitor for anemia or potential hemorrhage, but they do not provide information regarding the therapeutic range of warfarin anticoagulation. They are a consequence of monitoring for safety, not a tool for medication titration.

This question addresses the monitoring requirements for beta-adrenergic antagonists used in ophthalmic preparations. It requires recognizing that even topical medications can cause systemic absorption, leading to cardiovascular effects like bradycardia, which necessitates assessment of the patient's pulse before drug administration.

Choice A rationale

While peripheral pulses assess circulation, they are not the primary systemic cardiovascular parameter affected by beta-blockers. Monitoring the heart rate is more direct and sensitive for detecting the specific systemic adverse effects of this class of ophthalmic medication.

Choice B rationale

Assessing orientation is part of a neurological assessment, not a specific priority for a patient receiving betaxolol eye drops. The nurse focuses on systemic effects relevant to the drug’s pharmacological category, which is cardiovascular rather than neurological in this context.

Choice C rationale

Although beta-blockers can mask the symptoms of hypoglycemia in diabetic patients, monitoring blood sugar is not the standard priority intervention before administering ophthalmic betaxolol. The most immediate systemic concern is potential bradycardia resulting from the drug's beta-1 blocking effects.

Choice D rationale

Betaxolol is a cardioselective beta-1 blocker. Even when administered topically to the eye, it can be systemically absorbed and cause bradycardia. Therefore, the nurse must assess the apical pulse rate before each dose to ensure the heart rate is within safe parameters.