# A 78-year-old client weighing 70 kg with a creatinine clearance (CrCl) of 22 mL/min is admitted for treatment of an acute pulmonary embolism. The provider orders enoxaparin 1 mg/kg subcutaneously every 12 hours. Which action by the nurse is most appropriate?

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> subject: Adverse Effects/Contraindications/Interactions  
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## Question

A 78-year-old client weighing 70 kg with a creatinine clearance (CrCl) of 22 mL/min is admitted for treatment of an acute pulmonary embolism. The provider orders enoxaparin 1 mg/kg subcutaneously every 12 hours. Which action by the nurse is most appropriate?

## Option

1. Administer enoxaparin 1 mg/kg subcutaneously every 12 hours as prescribed; plan to obtain an anti-Xa level 4 hours after the third dose, because the patient's renal impairment may alter pharmacokinetics despite subcutaneous administration.
2. Administer the enoxaparin 1 mg/kg subcutaneously every 12 hours as prescribed; low-molecular-weight heparins rely on hepatic clearance and are not eliminated renally, so even with a creatinine clearance of 22 mL/min, the regimen is appropriate.
3. For a patient with acute PE and a creatinine clearance of 22 mL/min, administer enoxaparin 0.5 mg/kg subcutaneously every 12 hours; this dose reduction accounts for the prolonged elimination half-life in renal impairment and maintains therapeutic anticoagulation.
4. Hold the dose and contact the prescriber to clarify, because severe renal impairment (CrCl **✔ Correct answer**

**Correct answer: 4**

## Explanation

Enoxaparin and renal impairment
Enoxaparin (LMWH) is renally cleared. In severe renal impairment (CrCl

## In-depth explanation

Clinical reasoning summary
Enoxaparin and renal impairment
Enoxaparin (LMWH) is renally cleared. In severe renal impairment (CrCl

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