Author Question: A postoperative patient will begin anticoagulant therapy with rivaroxaban Xarelto after knee ... (Read 43 times)

meagbuch · **on:** Jul 23, 2018

A postoperative patient will begin anticoagulant therapy with rivaroxaban Xarelto after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythro-mycin. 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 anticoagu-lant medication.
d. request an order to increase the dose of rivaroxaban.

Question 2

The nurse has just administered diphenhydramine (Benadryl) and morphine sulfate to a patient. An hour has passed, and the nurse is checking on the patient. The patient asks the nurse why he feels so drowsy. The nurse's best response would be

a. Both of these drugs pass the blood-brain barrier, resulting in sedation.
b. Both of these drugs cause toxicity, leading to sedation.
c. Your drowsiness is a result of an adverse drug reaction (ADR).
d. Both of these drugs act as competitive antagonists and lead to sedation.

kingdude89 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

B
Patients with impaired renal function who are taking macrolide antibiotics will experience in-creased levels of rivaroxaban, increasing the risk of bleeding. It is correct to discuss using a dif-ferent antibiotic if possible. The nurse should not administer the dose without discussing the sit-uation 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.

Answer to Question 2

A
Both diphenhydramine and morphine sulfate act by depressing the central nervous system, lead-ing to sedation.
These drugs do not lead to toxicity unless given in excessive doses.
Sedation is an expected side effect of these medications, not an adverse reaction.
These drugs are not competitive antagonists, but they do act on the central nervous system.

DIF: Cognitive Level: Analysis REF: pp. 35-36
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies