A provider has ordered oral voriconazole [Vfend] which is an azole medication for a patient who has a systemic fungal infection. The nurse obtains a medication history and learns that the patient takes anticoagulant medication Warfarin. The nurse will contact the provider to discuss which possibility?

Choice A reason:
Holding the heparin and notifying the provider is the appropriate action. The significant drop in platelet count suggests the possibility of heparin-induced thrombocytopenia (HIT), a serious complication of heparin therapy. Immediate discontinuation of heparin and further evaluation are necessary to manage this condition.

Choice B reason:
Requesting an order for vitamin K (phytonadione) is not appropriate in this scenario. Vitamin K is used to reverse the effects of warfarin, not heparin. The issue here is the potential for HIT, not an over-anticoagulation that requires vitamin K.

Choice C reason:
While requesting a PTT test is part of managing anticoagulation therapy, it is not the immediate priority in this case. The significant drop in platelet count is more concerning for HIT, which requires stopping heparin and notifying the provider for further evaluation.

Choice D reason:
Administering oxygen and notifying the provider is not specific to managing the issue of a significantly low platelet count in a patient on heparin. The primary concern here is the potential for HIT, which necessitates stopping the heparin.

Choice A reason:
Telling the patient to stop taking the medication if they experience constipation is not appropriate. While side effects should be reported to the healthcare provider, discontinuing the medication without professional guidance can lead to inadequate management of cholesterol levels. The nurse should advise the patient to consult their provider about any side effects.

Choice B reason:
Continuing an exercise program to increase HDL serum levels is important advice. Regular physical activity is beneficial in raising HDL (good cholesterol) levels, which help reduce the risk of heart disease. Exercise complements the effects of cholesterol-lowering medications and supports overall cardiovascular health.

Choice C reason:
Stating that the medication will replace other interventions is incorrect. Cholesterol-lowering medications should be part of a comprehensive treatment plan that includes lifestyle modifications such as diet, exercise, and weight management. These interventions work synergistically to improve lipid profiles and reduce cardiovascular risk.

Choice D reason:
Doubling the dose if a dose is missed is unsafe and not recommended. Patients should follow their prescribed dosing schedule and consult their healthcare provider for instructions if they miss a dose. Taking an extra dose can increase the risk of adverse effects and complications.