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A nurse is caring for a patient who has been prescribed warfarin [Coumadin] in addition to IV heparin therapy after experiencing an acute myocardial infarction (MI). The patient asks why both medications are necessary if they do similar things in preventing clots from forming in his body.

Which response by the nurse best explains why both medications are necessary? (Select all that apply.).

“Heparin works faster than warfarin, so it is given until warfarin reaches an effective level in your blood.”

“Heparin and warfarin work on different clotting factors in your blood, so they have a synergistic effect.”

“Heparin is given by injection, while warfarin is given by mouth, so they have different routes of administration.”

“Heparin prevents new clots from forming, while warfarin helps dissolve existing clots in your blood vessels.”

“Heparin has a shorter duration of action than warfarin, so it is easier to reverse if bleeding occurs.”.

Answer and Explanation

Correct Answer : A,E

Heparin works faster than warfarin, so it is given until warfarin reaches an effective level in your blood.

Heparin has a shorter duration of action than warfarin, so it is easier to reverse if bleeding occurs.

Choice B is wrong because heparin and warfarin do not have a synergistic effect.

They work on different clotting factors, but they do not enhance each other’s effects.

Choice C is wrong because the route of administration is not relevant to the rationale for using both medications.

Heparin and warfarin can be given by different routes, but that does not explain why they are both necessary.

Choice D is wrong because warfarin does not help dissolve existing clots.

Warfarin prevents the synthesis of vitamin K-dependent clotting factors, but it does not break down clots that have already formed.

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Correct Answer is B

Explanation

This statement indicates that the patient understands that rivaroxaban (Xarelto) is an anticoagulant that can increase the risk of bleeding and bruising.The patient should avoid activities that may cause injury, such as contact sports, sharp objects, or falls.

Choice A is wrong because aspirin is also an antiplatelet drug that can further increase the risk of bleeding when taken with rivaroxaban.The patient should not take aspirin or any other nonsteroidal anti-inflammatory drugs (NSAIDs) without consulting the prescriber.

Choice C is wrong because rivaroxaban can be taken with or without food.The patient does not need to take the medication with food to prevent stomach upset or absorption problems.

Choice D is wrong because rivaroxaban should be taken as prescribed and not stopped abruptly without consulting the prescriber.Stopping the medication can increase the risk of blood clots and stroke.The patient should not stop taking the medication even if they feel better or have no symptoms.

A. Bruising at injection site B. Redness at injection site C. Swelling in one leg D. Mild pain at injection site.

Correct Answer is C

Explanation

This is because swelling in one leg could indicate a new or worsening deep vein thrombosis (DVT), which is a serious condition that can lead to pulmonary embolism or other complications. The client should report this finding to the provider immediately and seek medical attention.

Choice A) Bruising at injection site is wrong because bruising is a common and expected side effect of enoxaparin therapy, especially if the client is using the same injection site repeatedly.

The client should be instructed to rotate the injection sites and apply gentle pressure after each injection to minimize bruising.

Choice B) Redness at injection site is wrong because redness is also a common and expected side effect of enoxaparin therapy, as it indicates a local inflammatory response to the medication.

The client should be advised to avoid rubbing or scratching the injection site and to apply a cold compress if needed.

Choice D) Mild pain at injection site is wrong because mild pain is also a common and expected side effect of enoxaparin therapy, as it reflects the needle insertion and the medication delivery.

The client should be reassured that the pain will subside shortly and to use a different injection site for the next dose.

Normal ranges for enoxaparin therapy are based on the client’s weight, indication, and renal function.

The usual dose for DVT prophylaxis is 40 mg subcutaneously once daily, and the usual dose for DVT treatment is 1 mg/kg subcutaneously every 12 hours.

The client should have regular blood tests to monitor the anti-factor Xa level, which should be between 0.5 and 1.0 IU/mL for DVT prophylaxis and between 0.6 and 1.0 IU/mL for DVT treatment.

The client should also have regular platelet counts to check for heparin-induced thrombocytopenia (HIT), which is a rare but serious complication of enoxaparin therapy that causes a drop in platelets and an increased risk of thrombosis.

The normal platelet count range is 150,000 to 450,000/mm3.

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Naxlex Comprehensive Predictor Exams

A patient has been prescribed rivaroxaban (Xarelto) for deep vein thrombosis (DVT). Which statement by the patient indicates understanding of medication teaching?

Correct Answer is B

Explanation

A nurse is caring for a client who has deep vein thrombosis and is receiving enoxaparin therapy subcutaneously once daily at home. The nurse should instruct the client to report which of the following findings immediately?

Correct Answer is C

Explanation

A nurse is caring for a client who has pulmonary embolism and is receiving alteplase via continuous IV infusion.The nurse should monitor for which adverse effects of this medication? (Select all that apply.)

A nurse is caring for a patient who is receiving heparin therapy via continuous IV infusion for treatment of deep vein thrombosis (DVT). The nurse should monitor which of the following laboratory values to evaluate therapeutic effectiveness of heparin therapy?

A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure what information is gathered correctly before initiating the drip? Select all that apply: *.

The nurse is caring for a patient who has received alteplase [Activase]. It is most important for the nurse to take which action?

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

A patient has been prescribed dabigatran (Pradaxa) for atrial fibrillation (AF). Which laboratory test should be monitored while on this medication?

The patient has been receiving heparin therapy for deep vein thrombosis (DVT). The patient’s activated partial thromboplastin time (aPTT) result is 90 seconds (therapeutic range: 60-80 seconds). What will be included in patient care? (Select all that apply.).