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 A

Explanation

A) Determine what time the dose is taken: The timing of medication administration, especially for stimulant medications like dextroamphetamine-amphetamine, can significantly impact sleep quality. If the client is taking the medication too late in the day, its stimulant effects may interfere with their ability to fall asleep at night. Therefore, assessing the timing of medication administration is crucial to determine if it correlates with the reported difficulty sleeping.
B) Ask about the client's bedtime routine: While bedtime routine can influence sleep quality, it may not directly address the issue of difficulty sleeping related to medication use. However, understanding the client's overall sleep habits and bedtime routine can provide valuable information for developing sleep hygiene recommendations.
C) Inquire about perceived anxiety: Anxiety can contribute to sleep disturbances, but in this context, the primary concern is the potential impact of dextroamphetamine-amphetamine on sleep. While anxiety assessment is important in comprehensive care, it may not directly address the client's reported difficulty sleeping specifically related to medication use.
D) Determine daily caffeine intake: Caffeine intake can affect sleep quality, but it may not be as directly relevant to the reported difficulty sleeping in the context of medication use. However, it's still valuable information to assess as part of the overall evaluation of sleep habits and factors contributing to sleep disturbances.

A. Positive guaiac of stool. B. Hematocrit 42% (0.42 volume fraction). C. Gastric pH 2.0. D. Hemoglobin 13 g/dL (130 g/L).

Correct Answer is A

Explanation

A) Positive guaiac of stool:
A positive guaiac test indicates the presence of occult (hidden) blood in the stool, which may suggest gastrointestinal bleeding. Given the client’s history of heartburn, indigestion, and self-treatment with ibuprofen and antacids, gastrointestinal irritation or ulceration may be occurring, leading to bleeding. Gastrointestinal bleeding can cause fatigue, dizziness, and other symptoms. Therefore, it is essential to report this finding immediately to the healthcare provider for further evaluation and management.

B) Hematocrit 42% (0.42 volume fraction):
A hematocrit level within the reference range (42% to 52%) is considered normal. While a slight decrease in hematocrit may indicate anemia, it is not an urgent finding that requires immediate reporting. The client’s hematocrit level of 42% is within the normal range, so it does not warrant immediate concern.

C) Gastric pH 2.0:
A gastric pH of 2.0 falls within the normal range (1.5 to 3.5) for gastric acid pH. This finding indicates normal gastric acidity and does not suggest an acute problem that requires immediate reporting to the healthcare provider.

D) Hemoglobin 13 g/dL (130 g/L):
A hemoglobin level of 13 g/dL is slightly below the lower end of the reference range (14 to 18 g/dL) but does not indicate a critical condition requiring immediate intervention. While it may suggest mild anemia, it is not an urgent finding that necessitates immediate reporting to the healthcare provider.

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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.

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Explanation

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