A patient with a deep vein thrombosis receiving a heparin infusion and warfarin (Coumadin) therapy develops bleeding gums. What action should the nurse take?
a. Notify the registered nurse.
b. Offer the patient a saline mouth rinse.
c. Turn off the heparin infusion immediately.
d. Tell the patient to gargle with mouthwash.
ANS: A
The RN and physician should be notified so coagulation testing can be done to determine what to do with the heparin drip and warfarin, which can cause bleeding. C. Turning off the heparin infusion is not within the licensed practical nurse's (LPN's) scope of practice. B. D. Offering a saline mouth rinse or gargling with mouthwash can be done later.
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