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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E","F"]
Explanation
Choice A reason: Applying a clean, dry dressing over the VTE/DVT site is not necessary. VTE/DVT usually involves deep veins where there are no visible wounds requiring dressings. This instruction is irrelevant to the management and discharge instructions for a patient with DVT on anticoagulant therapy.
Choice B reason: Monitoring activated partial thromboplastin time (aPTT) results is relevant for heparin therapy, not for warfarin. Warfarin therapy is monitored using the international normalized ratio (INR). Therefore, this instruction is not appropriate for a patient being discharged on warfarin.
Choice C reason: Administering the warfarin dose at the same time each day is crucial for maintaining consistent blood levels of the medication, ensuring its effectiveness. It helps to maintain steady anticoagulation and reduces the risk of complications associated with fluctuating blood levels of warfarin.
Choice D reason: Instructing the patient to take aspirin or NSAIDs as needed for pain is inappropriate because these medications can increase the risk of bleeding when taken with warfarin. Patients on warfarin should avoid these medications and use alternatives like acetaminophen (Tylenol) for pain relief.
Choice E reason: Advising the patient to use electric razors, not straight razors, when shaving is important to prevent cuts and bleeding. Warfarin increases the risk of bleeding, and using an electric razor minimizes the chance of nicks and cuts that could lead to significant bleeding.
Choice F reason: Monitoring the level of anticoagulation with warfarin using INR results is essential. Regular INR monitoring ensures that the patient maintains a therapeutic level of anticoagulation and helps prevent both clotting and bleeding complications. Adjustments to the warfarin dose are made based on INR results.
Correct Answer is B
Explanation
Choice A reason: Observing for signs of hypotension is not typically a primary concern for patients with Cushing syndrome. These patients are more likely to experience hypertension due to increased cortisol levels, which cause sodium and water retention, rather than hypotension. Therefore, while monitoring blood pressure is important, focusing specifically on hypotension is not relevant to the typical presentation of Cushing syndrome.
Choice B reason: Monitoring blood glucose levels is a crucial intervention for patients with Cushing syndrome. Increased cortisol levels lead to hyperglycemia and glucose intolerance. Patients may develop diabetes mellitus as a result of chronic hypercortisolism. Regular monitoring of blood glucose levels helps in managing and controlling hyperglycemia and adjusting medication as necessary to maintain stable glucose levels.
Choice C reason: Protecting the patient from exposure to infection is essential in caring for patients with Cushing syndrome. Elevated cortisol levels suppress the immune system, making patients more susceptible to infections. Implementing infection control measures, such as hand hygiene, using personal protective equipment, and monitoring for signs of infection, are vital to prevent complications and ensure patient safety.
Choice D reason: Restricting protein intake is not a recommended intervention for patients with Cushing syndrome. In fact, these patients often require a diet high in protein to counteract the muscle wasting and weakness caused by excessive cortisol levels. Adequate protein intake helps in maintaining muscle mass and overall health, making restriction counterproductive.
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