A nurse is caring for a client who has cirrhosis and a prothrombin time of 30 seconds. Which of the following medications should the nurse plan to administer?
Warfarin
Vitamin K
Heparin
Ferrous sulfate
The Correct Answer is B
A. Warfarin:
Warfarin is an anticoagulant that works by inhibiting the synthesis of certain clotting factors, including factors II, VII, IX, and X. While it is used to prevent thromboembolic events, in a client with cirrhosis and an elevated PT, the priority is addressing the coagulation factor deficiency rather than adding an anticoagulant.
B. Vitamin K:
Vitamin K is the antidote for warfarin, and it helps in the synthesis of clotting factors. In cirrhosis, there can be impaired synthesis of clotting factors due to liver dysfunction. Administering vitamin K can aid in correcting coagulation abnormalities.
C. Heparin:
Heparin is another anticoagulant, but it does not reverse the effects of warfarin. It works by a different mechanism and is typically used in acute settings, such as deep vein thrombosis or pulmonary embolism. It is not the primary intervention for an elevated PT in cirrhosis.
D. Ferrous sulfate:
Ferrous sulfate is an iron supplement and is not indicated for the correction of an elevated PT. Iron supplements are typically used to address iron deficiency anemia.
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Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
A. Is used to replace fluid loss.
Isotonic solutions, such as normal saline (0.9% NaCl) and lactated Ringer's solution, are used to replace fluid loss in situations such as dehydration, surgery, trauma, or other conditions where there is a need for fluid resuscitation.
B. Usually do not provide calories.
Isotonic solutions typically do not contain calories. They are designed primarily for fluid replacement and do not contribute to the nutritional needs of the patient.
C. Does not expand intravascular volume.
This statement is incorrect. Isotonic solutions are used to expand intravascular volume. When infused into the bloodstream, isotonic solutions help restore and maintain adequate blood volume. They do not cause significant shifts of fluids between compartments.
D. Mostly do not provide free water.
Isotonic solutions generally do not provide free water. They have the same osmolality as body fluids, meaning that they do not cause a net movement of water into or out of cells, and they maintain the osmotic balance.
E. Has the same osmolality as body fluids.
Isotonic solutions have the same osmolality as body fluids, which means they do not cause a net movement of water into or out of cells. This characteristic makes them suitable for situations where there is a need to expand intravascular volume without causing significant shifts in fluid compartments.
Correct Answer is D
Explanation
A. Provide oral hygiene.
Providing oral hygiene is important for the client's comfort and overall well-being. However, in the context of acute pancreatitis, the immediate priority is to address the gastrointestinal symptoms and prevent further pancreatic stimulation.
B. Assist the client to a side-lying position.
Assisting the client to a side-lying position can be beneficial for comfort and may help prevent complications such as aspiration. However, it is not the immediate priority after treating the pain. Withholding oral fluids and food takes precedence in the initial management of acute pancreatitis.
C. Auscultate the client's lungs.
Auscultating the client's lungs is a routine nursing assessment and is important for respiratory monitoring. However, in the context of acute pancreatitis, the primary focus is on addressing gastrointestinal symptoms, and respiratory assessment becomes more critical if respiratory distress is suspected.
D. Withhold oral fluids and food.
Withholding oral fluids and food is the priority intervention after treating the pain in acute pancreatitis. This is done to reduce pancreatic stimulation, allowing the pancreas to rest and recover. NPO (nothing by mouth) status is often initiated in the early management of acute pancreatitis.
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