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.


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.

Nursing

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