A nurse is caring for a client prescribed Levothyroxine. Whi… | MyMerci
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Medication AdministrationPPT
Question
A nurse is caring for a client prescribed Levothyroxine. Which nursing action is most appropriate regarding administering on an empty stomach in the morning and monitoring for signs of hyperthyroidism?
1Do not hold apixaban; instead, reduce dose to 2.5 mg twice daily to balance stroke prevention with bleeding risk; administer concurrent prohemostatic agents such as tranexamic acid 1 g IV every 8 hours to promote clot stability; provide supportive care with strict blood pressure control (systolic
2Hold apixaban; administer vitamin K 10 mg by slow intravenous infusion every 12 hours for 3 days to reverse anticoagulation; if INR remains elevated after 24 hours, consider fresh frozen plasma (FFP) 15 mL/kg; provide supportive care with blood pressure control, neurosurgery consult, and seizure precautions; monitor INR daily, observe for signs of thrombosis or fluid overload, and repeat CT head in 6 hours if neurological status declines.
3Hold apixaban; administer idarucizumab (Praxbind) per institutional protocol — 5 g IV push over 5 to 10 minutes in two consecutive 2.5 g doses; if idarucizumab is unavailable, consider activated charcoal if last dose less than 2 hours ago and hemodialysis; provide concurrent supportive care (blood pressure management, neurosurgery evaluation, seizure precautions); monitor for thrombotic complications and repeat neuroimaging if neurological status deteriorates.✓ Correct answer
4Hold apixaban; administer andexanet alfa (Andexxa) per institutional protocol — typically high-dose protocol given the recent dose and major bleed (800 mg IV bolus over ~30 minutes followed by 8 mg/min infusion up to 120 minutes); if andexanet alfa is unavailable, give 4-factor prothrombin complex concentrate (PCC) approximately 50 IU/kg; provide concurrent supportive care (BP control, neurosurgery consult, monitoring for thrombosis).
Explanation
When administering Levothyroxine, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
Clinical reasoning summary Andexanet alfa — Xa inhibitor reversal Andexanet alfa (Andexxa) is a recombinant modified, inactive factor Xa decoy that binds and sequesters direct Xa inhibitors (apixaban, rivaroxaban, edoxaban). It is FDA-approved for life-threatening or uncontrolled bleeding in patients on apixaban or rivaroxaban.
Dosing protocol depends on (a) which DOAC, (b) the dose given, and (c) time since the last dose: • Low-dose protocol (400 mg bolus + 4 mg/min for up to 120 min): apixaban ≤5 mg or rivaroxaban ≤10 mg, OR last dose ≥8 hours ago / unknown. • High-dose protocol (800 mg bolus + 8 mg/min for up to 120 min): apixaban >5 mg or rivaroxaban >10 mg given within the past 8 hours.
This client took apixaban 5 mg 6 hours ago. Most institutions select high-dose protocol for major intracranial bleed within 8 hours (some protocols choose by time alone, others by both dose and time — practice site protocols vary).
If andexanet alfa is not available or the institution uses an alternative, 4-factor PCC at 25–50 IU/kg is an accepted off-label alternative supported by guidelines and meta-analyses.
Concurrent priorities: stop apixaban, neurosurgery consult, BP control (target SBP