A client has been prescribed warfarin (Coumadin) for treatment of deep vein thrombosis (DVT). Which of the following instructions should the nurse include in patient teaching? Select all that apply.

Avoid foods that are high in vitamin K.

Take aspirin for pain relief.

Report any unusual bleeding to healthcare provider.

Use an electric razor when shaving.

Wear shoes that fit well and avoid tight clothing.

Answer and Explanation

Correct Answer : A,C,D

Warfarin (Coumadin) is a blood thinner that prevents blood clots from forming or growing larger.

It is used to treat or prevent deep vein thrombosis (DVT), a condition in which a blood clot forms in a vein deep in the body, usually in the legs.

It can also prevent pulmonary embolism (PE), a condition in which a blood clot breaks off and travels to the lungs, blocking blood flow and causing breathing problems.

Patients taking warfarin should follow these instructions:

• Avoid foods that are high in vitamin K.

Vitamin K is needed for the production of some clotting factors in the liver.

Warfarin blocks the action of vitamin K, and thus reduces the clotting ability of the blood.

However, if the intake of vitamin K varies significantly from day to day, it can affect the stability of the warfarin effect. Foods that are high in vitamin K include green leafy vegetables, such as spinach, kale, broccoli, cabbage, and lettuce, as well as some vegetable oils, such as soybean and canola. Patients should not avoid these foods completely, but they should keep their intake consistent and inform their doctor or pharmacist if they make any changes to their diet.

• Report any unusual bleeding to healthcare provider.

Warfarin can increase the risk of bleeding, especially if the dose is too high or if it interacts with other medications or supplements. Patients should notify their doctor or seek emergency care if they have any signs of bleeding, such as bruising, red or black stools, blood in the urine, coughing up blood, vomiting blood, nosebleeds, heavy menstrual bleeding, headaches, dizziness, weakness, or swelling. They should also inform their doctor of any other medications or supplements they are taking, including over-the-counter products and herbal remedies.

• Use an electric razor when shaving.

Warfarin can make the skin more prone to bleeding from minor cuts or injuries.

Patients should use an electric razor when shaving to reduce the risk of nicking themselves and causing bleeding. They should also use a soft toothbrush and avoid flossing if it causes bleeding. They should wear gloves when handling sharp objects or working in the garden.

Choice B and E are wrong because:

• Take aspirin for pain relief.

Aspirin is a medication that also prevents blood clots by inhibiting platelets, which are cells that stick together to form clots. Taking aspirin with warfarin can increase the risk of bleeding significantly and is not recommended unless prescribed by a doctor for a specific reason. Patients should avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, for pain relief unless advised by their doctor. They should also check the labels of any over-the-counter medications or supplements they use and avoid those that contain aspirin or NSAIDs.

• Wear shoes that fit well and avoid tight clothing.

This instruction is not related to warfarin therapy and does not affect its efficacy or safety.

However, it may be a general advice for patients with DVT to prevent further complications or discomfort. Wearing shoes that fit well and avoiding tight clothing can help improve blood circulation in the legs and prevent swelling or pain. Patients with DVT should also elevate their legs when possible and wear compression stockings if prescribed by their doctor.

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Correct Answer is ["A","C"]

Explanation

Heparin is an anticoagulant that inhibits blood clotting and prevents harmful clots from forming in blood vessels.However, heparin can also cause some serious side effects, such as bleeding, bruising, low platelet count, allergic reactions, and osteoporosis.

Therefore, patients who are at a high risk for developing these adverse effects should be monitored closely and have their heparin dose adjusted accordingly.

Choice A is correct because a patient who is post-op day 1 from brain surgery has a high risk of bleeding from the surgical site or intracranially.Heparin can increase this risk and cause life-threatening hemorrhage.

Therefore, this patient should not receive heparin unless absolutely necessary and under strict supervision.

Choice B is wrong because a patient with a pulmonary embolism (PE) is a candidate for heparin therapy.

A PE is a blood clot that blocks the blood flow to the lungs and can cause respiratory failure and death.Heparin can prevent the clot from becoming larger and causing more damage, and also prevent new clots from forming.

Therefore, this patient would benefit from heparin therapy and is not at a high risk of adverse effects.

Choice C is correct because a patient with active peptic ulcer disease (PUD) has a high risk of bleeding from the stomach or duodenum.

PUD is a condition where the lining of the digestive tract is eroded by stomach acid and bacteria.Heparin can worsen this condition and cause ulcer bleeding or perforation.

Therefore, this patient should avoid heparin therapy unless absolutely necessary and under strict supervision.

Choice D is wrong because a patient with uncontrolled atrial fibrillation (AF) is a candidate for heparin therapy.

AF is an irregular heartbeat that can cause blood clots to form in the heart chambers and travel to other organs, such as the brain or lungs.Heparin can prevent these clots from forming and reduce the risk of stroke or PE.

Therefore, this patient would benefit from heparin therapy and is not at a high risk of adverse effects.

Normal ranges of heparin depend on the type of heparin used (unfractionated heparin or low molecular weight heparin), the method of administration (intravenous or subcutaneous), and the indication for use (prophylaxis or treatment).Generally, the therapeutic range for heparin level is 0.3 - 0.7 U/mL, measured by anti-Xa assay.However, this range may vary depending on the pregnancy stage and the type of heparin used.The dose of heparin should be individualized according to the results of suitable laboratory tests and clinical response.

A. Headache B. Fever C. Chest pain D. Backache E.

Correct Answer is ["A","E"]

Explanation

The nurse should include headache and dyspnea as potential adverse effects of bivalirudin.According to the drug information from various sources, bivalirudin can cause common side effects such as headache, nausea, low or high blood pressure, chest pain, abdominal pain, and shortness of breath (dyspnea).

These side effects should be reported to the provider if they are severe or persistent.

Choice B is wrong because fever is not a common side effect of bivalirudin.

However, fever can be a sign of infection or an allergic reaction to the drug, which should be reported to the provider immediately.

Choice C is wrong because chest pain is not an adverse effect of bivalirudin, but rather a symptom of angina, which is one of the conditions that bivalirudin is used to treat.

Chest pain can also indicate a heart attack or other serious cardiac problems, which require immediate medical attention.

Choice D is wrong because backache is not a common side effect of bivalirudin.

However, backache can be a sign of bleeding in the kidneys or other organs, which can be a serious complication of bivalirudin therapy.

Therefore, any unusual pain or swelling in the back or abdomen should be reported to the provider as soon as possible.

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A client has been prescribed warfarin (Coumadin) for treatment of deep vein thrombosis (DVT). Which of the following instructions should the nurse include in patient teaching? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all that apply:

Correct Answer is ["A","C"]

Explanation

A nurse is teaching a client who has a new prescription for bivalirudin about potential adverse effects of the drug. Which of the following effects should the nurse include? (Select all that apply.)

Correct Answer is ["A","E"]

Explanation

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