A client with atrial fibrillation receives a new prescription for dabigatran. Which instruction should the nurse include in this client's teaching plan?

Eliminate spinach and other green vegetables in the diet.

Continue obtaining scheduled laboratory bleeding tests.

Keep an antidote available in the event of hemorrhage.

Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Answer and Explanation

The Correct Answer is D

Choice A reason: Spinach and other green vegetables are rich in vitamin K, which is essential for blood clotting. However, dabigatran is not affected by vitamin K intake, unlike warfarin, another anticoagulant drug. Therefore, there is no need to eliminate these foods from the diet.

Choice B reason: Dabigatran does not require routine laboratory monitoring of bleeding parameters, such as prothrombin time (PT) or international normalized ratio (INR), unlike warfarin. Therefore, the client does not need to continue obtaining scheduled laboratory bleeding tests.

Choice C reason: Dabigatran is a direct thrombin inhibitor that prevents the formation of fibrin, the main component of blood clots. In case of a major bleeding event, the antidote for dabigatran is idarucizumab, a monoclonal antibody that binds to dabigatran and reverses its effect. However, this antidote is not readily available in most settings and should only be administered by a health care provider. Therefore, the client should not keep an antidote available at home.

Choice D reason: NSAIDs, such as ibuprofen or naproxen, can increase the risk of bleeding by inhibiting platelet aggregation and damaging the gastric mucosa. Therefore, the client should avoid using these drugs while taking dabigatran. The client should consult with the prescriber before taking any other medications, including over-the-counter or herbal products.

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Correct Answer is C

Explanation

Choice A reason: Providing a heating pad to the client may provide some temporary relief, but it does not address the underlying cause of the neck discomfort, which is likely due to extrapyramidal side effects (EPS) of the antipsychotic medication.

Choice B reason: Obtaining a prescription for physical therapy services may be beneficial for the client's overall health and well-being, but it is not the best intervention for the acute problem of neck discomfort. Physical therapy may also require a referral and a waiting period, which would delay the relief for the client.

Choice C reason: Giving a PRN prescription for benztropine is the best intervention for the nurse to implement, as benztropine is an anticholinergic medication that can counteract the EPS of the antipsychotic medication. Benztropine can reduce the muscle stiffness and spasms that cause the neck discomfort.

Choice D reason: Obtaining an extra pillow for the client to use at night may help the client sleep better, but it does not address the neck discomfort during the day. It also does not treat the EPS of the antipsychotic medication, which may worsen over time.

A. Lorazepam. B. Digoxin. C. Sucralfate. D. Vancomycin.

Correct Answer is D

Explanation

Choice A reason: Lorazepam is a benzodiazepine that is used to treat anxiety, insomnia, and seizures. It is metabolized by the liver and does not have a significant effect on the kidneys. The nurse should monitor the client for signs of sedation, respiratory depression, and dependence.

Choice B reason: Digoxin is a cardiac glycoside that is used to treat heart failure and arrhythmias. It is eliminated by the kidneys and can cause toxicity if the renal function is impaired. The nurse should monitor the client's serum digoxin level, heart rate, and rhythm, and signs of toxicity, such as nausea, vomiting, visual disturbances, and confusion.

Choice C reason: Sucralfate is a mucosal protectant that is used to treat peptic ulcer disease. It forms a protective barrier over the ulcer and does not get absorbed into the bloodstream. It does not affect the kidneys and has few side effects. The nurse should monitor the client's symptoms and advise them to take the medication on an empty stomach.

Choice D reason: Vancomycin is an antibiotic that is used to treat serious infections caused by gram-positive bacteria. It is nephrotoxic and can cause AKI, especially in high doses or prolonged use. The nurse should monitor the client's serum vancomycin level, renal function tests, urine output, and signs of AKI, such as oliguria, edema, and electrolyte imbalances.

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A client with atrial fibrillation receives a new prescription for dabigatran. Which instruction should the nurse include in this client's teaching plan?

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