Medical Surgical Labs Coagulation Panel #5

Question

A nurse receives an order for a subcutaneous enoxaparin injection for her postoperative female client. She notices the client’s hemoglobin and hematocrit is 9 and 33. What action should the nurse take next?

Answers

  1. Assess the client's blood pressure.
    • Rationale:

      This answer is correct because the client has a slightly low hemoglobin and hematocrit. The nurse should assess the blood pressure and if it is low, should notify the provider for clarification. A low H & H with a low BP indicates active bleeding.

  2. Assess for signs of bleeding.
    • Rationale:

      This answer is not correct because it is not the next action the nurse should take next. Assessing the blood pressure value is more of an objective approach to give information to the provider about the client’s volume status rather than assessing for signs of bleeding at that moment.

  3. Administer the injection.
    • Rationale:

      This answer is not correct because the hemoglobin is not within normal range. Enoxaparin can further increase blood loss in a client who is actively bleeding.

  4. Contact the healthcare provider.
    • Rationale:

      This answer is not correct because more information is required. The nurse should be prepared to provide the healthcare provider with not only the lab values, but also the blood pressure, and assessment findings that indicate a problem.

Overview

Enoxaparin is a low molecular weight heparin and does not require frequent lab studies. However, if the client has a slightly low hemoglobin and hematocrit along with a decrease in blood pressure by 20 points, the healthcare provider should be notified and the order clarified.

Explanation

Learning Outcomes

Enoxaparin is a low molecular weight heparin and does not require frequent lab studies. It is frequently given to clients after surgery to prevent the formation of blood clots. It is given by subcutaneous injection. Side effects include bleeding, anemia, and bruising at the sites of injection. Platelets and H&H are labs that will be monitored for clients receiving enoxaparin. An order for enoxaparin should be clarified if the client has a slightly low H&H. Taking the blood pressure will provide the provider with more information to decide whether or not to continue the order.

Test Taking Tip

Using your nursing knowledge, put yourself in the nurse’s shoes and answer the question before looking at the choices.

Video Rationale