# The nurse reviews a fondaparinux prescription for postoperative venous-thromboembolism prophylaxis. Which findings require clarification or immediate follow-up? Select exactly 4 responses.

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

The nurse reviews a fondaparinux prescription for postoperative venous-thromboembolism prophylaxis. Which findings require clarification or immediate follow-up? Select exactly 4 responses.

Select exactly 4 responses.

1

The abdominal incision is dry and intact 10 hours after surgery.

2

The initial dose is scheduled 2 hours after surgery before hemostasis is established.

3

The client weighs 72 kg and creatinine clearance is 78 mL/min.

4

Active gastrointestinal bleeding is documented.

5

Creatinine clearance is 24 mL/min.

6

The client weighs 46 kg.

## Explanation

Fondaparinux prophylaxis is contraindicated with creatinine clearance below 30 mL/min, adult body weight below 50 kg, or active major bleeding. Postoperative prophylaxis begins only after hemostasis and no earlier than 6 to 8 hours after surgery.

## In-depth explanation

Quick answer
Check kidney function, body weight, active bleeding, and postoperative timing.

Why this is correct
Fondaparinux is eliminated unchanged by the kidneys and can produce prolonged anticoagulation with renal impairment. Low body weight and dosing before hemostasis increase major bleeding risk.

Easy analogy or mental picture
Build a medication safety chain: identify the cue cluster, connect it to the drug mechanism, stop preventable exposure, stabilize the client, and verify the response with measurable findings.

Memory hook
Cue cluster, medication mechanism, protective action, and measurable reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving treatment for the underlying condition.

Why the other choices are wrong
Options that rely on one reassuring value, continue a suspect exposure, bypass monitoring, or delay escalation leave the medication hazard active.References
1DailyMed: ARIXTRA (fondaparinux) prescribing informationRenal contraindication, low-weight prophylaxis restriction, bleeding, neuraxial hematoma, and monitoring

## Clinical scenario

Medication-safety review
Verify the indication, current assessment, laboratory trend, timing, route, interactions, authorized action, and measurable follow-up.

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