A client who is taking warfarin has an international normalized ratio (INR) of 0.8. Which question should a nurse ask to further evaluate the client?

Do your gums bleed when you brush your teeth?.

Are you taking the medication as prescribed?.

Have you noticed blood in your stools?.

Do you have any unusual bruising?.

Answer and Explanation

The Correct Answer is B

Are you taking the medication as prescribed? This is because warfarin is a blood-thinning medication that affects the prothrombin time (PT) and the international normalized ratio (INR).

The PT measures how long it takes for blood to clot, and the INR is a calculation based on the PT that standardizes the results across different laboratories. A normal INR range is 0.8 to 1.1 for people who are not taking warfarin. People who take warfarin usually have a target INR range of 2 to 3, depending on their condition.

An INR of 0.8 means that the blood clots faster than normal, which increases the risk of blood clots and strokes.

This could indicate that the client is not taking enough warfarin or is taking other medications or foods that interfere with warfarin’s effect.

Choice A is wrong because bleeding gums are a sign of excessive bleeding, which could happen if the INR is too high, not too low.

Choice C is wrong because blood in stools is also a sign of excessive bleeding, which could happen if the INR is too high, not too low.

Choice D is wrong because unusual bruising is another sign of excessive bleeding, which could happen if the INR is too high, not too low.

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Correct Answer is B

Explanation

To explain why, we need to use the formula for calculating the drip rate in drops per minute (dpm):

Volume of IV fluid (mL) x Drop Factor (drops/mL) / Time to run (h) x 60 (min/h) = Drip Rate (dpm)

In this question, the volume of IV fluid is one liter, which is equivalent to 1000 mL. The drop factor is 15 drops per mL, as given by the tubing.

The time to run is six hours, as ordered by the physician. Plugging these values into the formula, we get:

1000 mL x 15 drops/mL / 6 h x 60 min/h = 84 dpm

Therefore, the nurse should regulate the infusion to deliver 84 drops per minute.

Choice A is wrong because it gives a drip rate of 42 drops per minute, which is half of the correct answer.

This would result in delivering only 500 mL of normal saline in six hours, instead of one liter.

Choice C is wrong because it gives a drip rate of 100 drops per minute, which is more than the correct answer.

This would result in delivering 1.43 liters of normal saline in six hours, instead of one liter.

Choice D is wrong because it gives a drip rate of 166 drops per minute, which is almost double the correct answer.

This would result in delivering 1.99 liters of normal saline in six hours, instead of one liter.

Normal saline is a solution of 0.9% sodium chloride in water, which has the same osmolarity as blood plasma.

It is used to treat dehydration, shock, blood loss, and other conditions that require fluid replacement.

The normal range of sodium in blood is 135-145 mEq/L.

A. Select an insulin syringe, 31 gauge 6 mm needle and inject insulin at a 45-degree angle. B. Select a 0.5 mL syringe, 30 gauge, 8 mm needle and inject at a 90-degree angle. C. Select a 0.5 mL syringe, 29 gauge 8 mm needle, pinch the skin, and inject at 45 degrees. D. Select a 1.0 mL syringe, 28 gauge 12.7 mm needle, and inject at 90 degrees.

Correct Answer is B

Explanation

Select a 0.5 mL syringe, 30 gauge, 8 mm needle and inject at a 90-degree angle. This is because Humulin R is a clear and colorless solution that can be given by subcutaneous injection.

A 0.5 mL syringe can hold up to 50 units of insulin, which is enough for the prescribed dose of 7 units. A 30 gauge, 8 mm needle is suitable for thin patients with poor skin turgor. Injecting at a 90-degree angle ensures that the insulin reaches the subcutaneous tissue and not the muscle.

Choice A is wrong because a 31 gauge, 6 mm needle is too short and may not deliver the insulin into the subcutaneous tissue.

Choice C is wrong because pinching the skin is not necessary for thin patients with poor skin turgor.

Choice D is wrong because a 1.0 mL syringe is too large for the prescribed dose of 7 units and may cause dosing errors. A 28 gauge, 12.7 mm needle is too long and may inject the insulin into the muscle, which can affect its absorption and action.

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A client who is taking warfarin has an international normalized ratio (INR) of 0.8. Which question should a nurse ask to further evaluate the client?

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Naxlex Comprehensive Predictor Exams

A client is to receive one liter of normal saline intravenously over six hours. The tubing delivers 15 drops per milliliter. How many drops per minute should a nurse regulate the infusion to deliver?

Correct Answer is B

Explanation

The client has diabetes Type I, a body mass index (BMI) of 17 and poor skin turgor. How should the nurse plan to administer the prescribed. Humulin R 7 units subcutaneously?

Correct Answer is B

Explanation

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