A 55-year-old male was admitted 1 week ago for a left lower leg venous thromboembolism, confirmed by ultrasound. He started to work from home 4 months ago and reports that his activity level has significantly decreased. When admitted, his left lower leg had 3+ edema and was warm and reddened over the calf area. He was immediately started on intravenous heparin therapy, with warfarin (Coumadin) on the same day. The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate?

Taking two medications dissolves the blood clot much faster.

Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner.

Heparin will start to dissolve the clot, and warfarin will prevent any more clots from forming.

Heparin works right away, but warfarin takes several days to prevent clots.

Answer and Explanation

The Correct Answer is D

Choice A reason: This statement is incorrect because the combination of heparin and warfarin does not dissolve the blood clot faster. Instead, these medications have different mechanisms of action. Heparin works quickly to prevent further clot formation, while warfarin takes several days to reach therapeutic levels and maintain anticoagulation over the long term.
Choice B reason: While the risk of a blood clot in the lungs (pulmonary embolism) is a concern, the necessity of using both heparin and warfarin is not because of the need for multiple blood thinners but rather due to their complementary pharmacokinetics. Heparin provides immediate anticoagulation, whereas warfarin requires time to become effective.
Choice C reason: This statement is also incorrect. Heparin does not dissolve clots but works to prevent the extension of existing clots and the formation of new ones. Warfarin, likewise, does not dissolve clots but prevents further clot formation by inhibiting vitamin K-dependent clotting factors.
Choice D reason: This is the accurate response. Heparin works immediately, providing rapid anticoagulation, which is essential for acute management of venous thromboembolism. On the other hand, warfarin takes several days to achieve its anticoagulant effect because it works by inhibiting the synthesis of vitamin K-dependent clotting factors. Therefore, the patient is initially placed on heparin to provide immediate protection against clotting while warfarin is started simultaneously. Once warfarin reaches a therapeutic level, heparin can be discontinued, and warfarin can maintain long-term anticoagulation.

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Correct Answer is B

Explanation

Choice A reason: Monitoring potassium levels is essential for various medical conditions, but it is not specifically used to evaluate the effects of therapy for acute pancreatitis. Potassium levels may be monitored to assess overall electrolyte balance and kidney function, but they do not provide direct information about pancreatic inflammation or damage.
Choice B reason: Monitoring lipase levels is crucial in evaluating the effects of therapy for a patient with acute pancreatitis. Lipase is an enzyme produced by the pancreas, and its levels rise significantly during an acute episode of pancreatitis. Elevated lipase levels are a sensitive and specific indicator of pancreatic inflammation and damage. By regularly measuring lipase levels, healthcare providers can assess the severity of the condition, monitor the patient's response to treatment, and make necessary adjustments to the therapeutic regimen.
Choice C reason: Calcium levels are not typically used to evaluate the effects of therapy for acute pancreatitis. Although hypercalcemia (high calcium levels) can be a risk factor for developing pancreatitis, monitoring calcium levels is not a standard method for assessing the effectiveness of treatment for the condition.
Choice D reason: Bilirubin levels are not directly related to the evaluation of therapy for acute pancreatitis. Bilirubin is a breakdown product of hemoglobin and is primarily used to assess liver function and diagnose conditions such as jaundice or liver disease. While liver function tests may be performed in patients with pancreatitis to rule out concurrent liver issues, bilirubin levels alone do not provide information about the effectiveness of therapy for pancreatitis.

A. Ask the nursing assistant to determine if he can safely sit in a bedside chair. B. Passive ROM exercise. C. Assess neurologic status. D. Coordinate with speech therapy to perform a swallowing evaluation. E. Use pillows and positioning devices to maintain proper body alignment. F. Pull on his arm to position him on his side.

Correct Answer is ["B","C","D","E"]

Explanation

Choice A reason: Asking the nursing assistant to determine if Marvin can safely sit in a bedside chair is not appropriate. Safety assessments, especially for patients with recent neurological events, should be done by a registered nurse or a physical therapist. This ensures that any nuanced clinical signs indicating instability or risk are recognized and addressed promptly.
Choice B reason: Passive range of motion (ROM) exercises are essential for patients with hemiplegia to prevent complications such as muscle atrophy, joint contractures, and decreased circulation. Regularly performing these exercises can maintain the health of the muscles and joints, promote better blood flow, and help in maintaining some degree of flexibility in the affected limbs.
Choice C reason: Assessing neurologic status is crucial in patients who have had a recent stroke and received tPA treatment. Frequent neurologic assessments help in monitoring for any changes or signs of deterioration. This includes checking consciousness, pupil response, motor function, and sensory perception. Changes in these parameters can indicate complications or the need for immediate medical interventions.
Choice D reason: Coordinating with speech therapy for a swallowing evaluation is essential because Marvin has dysphagia. Swallowing assessments by a speech therapist can determine the patient's ability to swallow safely and the appropriate dietary modifications needed to prevent aspiration, a common risk in patients with dysphagia. This is vital to prevent pneumonia or other respiratory complications.
Choice E reason: Using pillows and positioning devices to maintain proper body alignment is important in preventing complications such as pressure ulcers, muscle contractures, and discomfort. Proper positioning can also assist in maintaining better respiratory function and overall comfort. It also prevents the development of deformities and promotes functional posture, which is especially important for patients with hemiplegia.
Choice F reason: Pulling on his arm to position him on his side is inappropriate and can cause injury, especially in a patient with hemiplegia. This technique can lead to shoulder dislocations or increased pain. Instead, proper repositioning techniques using assistive devices and help from additional staff members should be employed to ensure safe and effective movement of the patient.

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Naxlex Comprehensive Predictor Exams

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?

Correct Answer is B

Explanation

Marvin is transferred from the ICU to the Tele/Neuro unit 24 hours after receiving tPA. He has left sided hemiplegia with some dysphagia. What nursing interventions should be part of his plan of care? Select all that apply.

Correct Answer is ["B","C","D","E"]

Explanation

Interpret these clinical findings and determine the nurse's next action. Clinical Findings: Complaints of dizziness and unsteady gait. BP: 98/60 mmHg. Carbidopa-Levodopa last taken 30 minutes ago.

In a severely anemic patient, which assessment findings would the nurse expect to find?

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency (Addison's Disease)?

Which IV fluid is the most appropriate for treating acute Diabetes insipidus (DI)?

Determine the flow rate in mL per hour for the following IV being administered by infusion pump: Ampicillin 1.5g in 100 mL 0.9% NS over 45 minutes: Round to the whole number.