Exam question - Heparin Side Effects

Esme12, ASN, BSN, RN · Oct 16, 2014

What do you think?

tsm007 · Oct 16, 2014

You know I have to be honest I have gotten better at answering these questions because I've stopped over thinking them. If I was at home and had a nasty side effect from a medication what would *I* do first? Take the medicine, call the doctor...

203bravo, MSN, APRN · Oct 16, 2014

Have to agree with tsm --- when thinking about each choice all can be easily eliminated except (a)

NuGuyNurse2b · Oct 16, 2014

I'm not sure what's happening here. So luv2run, you are soliciting feedback on an exam question you wrote?

NurseGirl525, ASN, RN · Oct 16, 2014

Seeing as how Coumadin and heparin are both blood thinners, I wouldn't give them Coumadin. They will bleed out. Bleeding gums is a very common side effect of these drugs. Although it can be an indication that their blood is too thin. I was on Coumadin for about 3 years and my gums bled every time I brushed my teeth. You don't want to stop it as their blood would thicken and they could get a clot.

unicoRNurse · Oct 16, 2014

In some places (Canada, for one) they say they "wrote" an exam instead of saying they "took" an exam. I don't believe the OP is the author of the test.

luv2run851 · Oct 19, 2014

Ya, Canadian here, and yes I "took" the exam (not sure where I "took" it to though?).

Hmmm, overthinking things can be the downfall, for sure. I have discussed with other students who also 'took' the exam and answers are between either informing the doctor, stopping the med, and reassuring the patient. My personal thought was to reassure pt. because it's only bleeding gums and the pt is not bleeding out or anything, I don't think that I would inform the doctor FIRST, because I can hear my instructor in my head telling me that we are RNs and not LPNs, we need to be able to think critically (not that I wouldn't inform the doc, just not first). As for stopping the med, I assume the patient is on it because he is at risk for developing clots leading to an MI/PE/stroke and I would think that an MI/PE/stroke would be worse than bleeding gums. I suppose in my mind it comes down to either holding the dose (and then checking with the doc) or giving the dose, and whether or not bleeding gums is considered a mild side effect or is it a sign of something worse. Of course instructors won't answer these questions for you and the notes list bleeding as an adverse effect but don't really go into that much detail as to how much bleeding is bad (GI bleed - bad, gums - not sure), which is why I thought I might get an answer here.

NuGuyNurse2b · Oct 20, 2014

Ya, Canadian here, and yes I "took" the exam (not sure where I "took" it to though?).

Well it's a different definition of the verb to take. You take a bath, right? It's not the same as saying you take the car to the store. I guess it's colloquial. I've just never seen it written that way.

Your line of reasoning is what I was doing in first semester and it got me in trouble, too. You're definitely overthinking it - NCLEX tells you to only use what's given in the question - you're doing the "what if's" which will introduce new information. While you are correct that we should know what is an "acceptable" level of bleeding (since it is a side effect of the medication) - that threshold is set by...you guessed, it...the doctor. So you would still have to pick option A for this question.

tsm007 · Oct 20, 2014

Here's a link for you because I wanted to be sure my answer was right since I'm still a student too. http://www.online-nursing-dot.com/nurse-exam.html Question 10 is almost the same question as yours. Hope that helps.

luv2run851 · Oct 27, 2014

Thanks so much for the responses, you've definitely got me thinking (or thinking less :)