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) Monitor blood pressure:
This is the correct answer. Tamsulosin, like other alpha-blockers, can cause orthostatic hypotension, which is characterized by a sudden drop in blood pressure when transitioning from lying down or sitting to standing. Monitoring blood pressure, particularly when initiating therapy or adjusting the dosage, helps detect and manage hypotensive episodes. Clients should be advised to change positions slowly to minimize the risk of falls or injury.

B) Assess urine output:
While tamsulosin can affect urinary function by relaxing smooth muscle in the prostate and bladder neck, it typically does not significantly impact urine output. Therefore, monitoring urine output is not a primary intervention for assessing adverse reactions to tamsulosin.

C) Obtain daily weights:
Tamsulosin is not typically associated with significant fluid retention or changes in body weight. Daily weight measurements are more relevant for assessing fluid balance in clients receiving medications such as diuretics or those with conditions like heart failure or renal disease.

D) Perform a bladder scan:
Tamsulosin does not directly affect bladder volume or urinary retention to the extent that necessitates routine bladder scanning. Bladder scans are typically performed in clients with suspected urinary retention or those at risk for urinary retention due to conditions like BPH, but it's not a standard intervention for monitoring adverse reactions to tamsulosin.

A. Stop the oral contraceptive immediately. B. Use an additional form of contraception. C. Take the medications at least 12 hours apart. D. Avoid prolonged exposure to direct sunlight

Correct Answer is B

Explanation

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

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

C) Take the medications at least 12 hours apart:
While spacing medications apart can sometimes minimize 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 sufficiently prevent contraceptive failure.

D) Avoid prolonged exposure to direct sunlight:
This instruction is unrelated to the interaction between erythromycin and oral contraceptives. While erythromycin can increase sensitivity to sunlight (photosensitivity), it does not directly 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.

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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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