Final answer:
The nurse should b. notify the provider to discuss changing the patient's antibiotic due to the potential interaction between erythromycin and rivaroxaban, which could increase the risk of bleeding.
Step-by-step explanation:
A postoperative patient who is to begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery and is taking erythromycin, with a creatinine clearance of 50 mL/min, prompts a particular clinical consideration.
The fact that the patient is taking erythromycin is significant because erythromycin can inhibit the metabolism of rivaroxaban, leading to increased levels of the anticoagulant and potentially increasing the risk of bleeding.
When faced with this scenario, the correct course of action would be to b. notify the provider to discuss changing the patient's antibiotic.
Alternative antibiotics that do not interact with rivaroxaban should be considered to minimize the risk of adverse effects.
It is not recommended to administer the first dose of rivaroxaban without considering the potential interaction, nor to request an order to increase the dose of rivaroxaban, as this could exacerbate the potential for bleeding.
Requesting an order for a different anticoagulant medication may be an option but would depend on the complete clinical picture and provider's judgment.