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The nurse is reviewing new medication orders for a patient who has an epidural catheter for administration of pain medications. One of the orders is for enoxaparin, a low-molecular-weight heparin (LMWH). What is the nurse's priority action?
- A. Give the LMWH as ordered.
- B. Double-check the LMWH order with another nurse, and then administer as ordered.
- C. Stop the epidural pain medication, and then administer the LMWH.
- D. Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.
Correct Answer: D
Rationale: LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma.
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A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication?
- A. Aspirin needs to be taken on an empty stomach to ensure maximal absorption.
- B. Low-dose aspirin therapy rarely causes problems with bleeding.
- C. Take the medication with 6 to 8 ounces of water and with food.
- D. Coated tablets may be crushed if necessary for easier swallowing.
Correct Answer: C
Rationale: Enteric-coated aspirin is best taken with 6 to 8 ounces of water and with food to help decrease gastrointestinal upset. Enteric-coated tablets should not be crushed. Risk for bleeding increases with aspirin therapy, even at low doses.
When administering heparin subcutaneously, the nurse will follow which procedure?
- A. Aspirating the syringe before injecting the medication
- B. Massaging the site after injection
- C. Use the same area for each injection.
- D. Using a 1/2- to 5/8-inch 25- to 27-gauge needle
Correct Answer: D
Rationale: A 1/2- to 5/8-inch 25- to 27-gauge needle is the correct needle to use for a subcutaneous heparin injection. Aspirating before the injection and massaging the site after the injection encourage hematoma formation at the injection site. Injection sites need to be rotated with each injection.
The nurse notes in the patient's medication orders that the patient will be starting anticoagulant therapy. What is the primary goal of anticoagulant therapy?
- A. Stabilizing an existing thrombus
- B. Dissolving an existing thrombus
- C. Preventing thrombus formation
- D. Dilating the vessel around a clot
Correct Answer: C
Rationale: Anticoagulants prevent thrombus formation but do not dissolve or stabilize an existing thrombus, nor do they dilate vessels around a clot.
An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose.
Correct Answer: 0.8 mL
Rationale: 5000 units : 1 mL :: 4000 units : x mL; (5000 * x) = (1 * 4000); 5000x = 4000; x = 4000/5000 = 0.8 mL.
A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose?
- A. Vitamin E
- B. Vitamin K
- C. Protamine sulfate
- D. Potassium chloride
Correct Answer: C
Rationale: Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect.