A patient who is taking warfarin (Coumadin) has just vomited ...

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A patient who is taking warfarin (Coumadin) has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer:
 
  a. phytonadione (vitamin K1) 1 mg IV over 1 hour.
  b. phytonadione (vitamin K1) 2.5 mg PO.
  c. protamine sulfate 20 mg PO.
  d. protamine sulfate 20 mg slow IV push.

Question 2

A postoperative patient will begin anticoagulant therapy with rivaroxaban (Xarelta) after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin.
 
  The patient's creatinine clearance is 50 mL/min. The nurse will:
  a. administer the first dose of rivaroxaban as ordered.
  b. notify the provider to discuss changing the patient's antibiotic.
  c. request an order for a different anticoagulant medication.
  d. request an order to increase the dose of rivaroxaban.

[Jsherida]

Answer to Question 1

ANS: A
Vitamin K1 is given for warfarin overdose and may be given IV in an emergency. To reduce the incidence of an anaphylactoid reaction, it should be infused slowly. In a non-emergency situation, it would be appropriate to give vitamin K1 orally. Protamine sulfate is used for heparin overdose.

Answer to Question 2

ANS: B
Patients with impaired renal function who are taking macrolide antibiotics will experience increased levels of rivaroxaban, increasing the risk of bleeding. It is correct to discuss using a different antibiotic if possible. The nurse should not administer the dose without discussing the situation with the provider. The patient's renal impairment is minor; if it were more severe, using a different anticoagulant might be appropriate. It is not correct to increase the dose of rivaroxaban.

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TYSM

[scottmt]

Thanks for the timely response, appreciate it