While receiving a heparin infusion to treat deep vein thrombosis, a client reports that the gums bleed when brushing the teeth. What should the nurse do first?

Notify the physician.

Because bleeding gums are an adverse effect of heparin that may indicate excessive anticoagulation, the nurse should notify the physician, who will evaluate the clients condition. Laboratory tests, such as partial thromboplastin time, should be performed before concluding that the clients bleeding is significant. The prescribed heparin dose may be therapeutic rather than excessive, so the nurse shouldnt discontinue the heparin infusion, unless the physician orders this after evaluating the client. Protamine sulfate, not a coumarin derivative, is given to counteract heparin. Bleeding gums arent a normal effect of heparin.