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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 ["C","E"]

Explanation

Verapamil is a calcium channel blocker that is used to treat variant angina by dilating the coronary arteries and relieving the chest pain caused by spasms.It also reduces blood pressure and heart rate, but these are not the expected outcomes for variant angina.

Choice A is wrong because verapamil decreases heart rate, not increases it.This can help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.

Choice B is wrong because verapamil decreases contractility, not increases it.This can also help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.

Choice D is wrong because verapamil reduces blood pressure, not increases it.This can help lower the workload of the heart, but it is not the main goal of therapy for variant angina.

Normal ranges for heart rate are 60 to 100 beats per minute, for blood pressure are 120/80 mm Hg or lower, and for contractility are measured by ejection fraction, which is normally 55% or higher.

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 nurse is caring for a client who has variant angina and is prescribed verapamil. Which of the following are expected outcomes of this medication? (Select all that apply.)

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

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 patient who has been prescribed apixaban (Eliquis) for deep vein thrombosis (DVT). Which instructions should be included in patient teaching? Select all that apply.

A nurse is reviewing the medication list of a client who is prescribed dabigatran and has a history of peptic ulcer disease. The nurse should recognize that which of the following medications can increase the risk of bleeding in this client?

A nurse is caring for a client who is receiving argatroban IV for HIT and requires urgent surgery. The nurse should stop the infusion at least how many hours before the surgery?

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? 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?

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 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.)

A client who has atrial fibrillation is prescribed dabigatran etexilate mesylate (Pradaxa). The nurse should instruct the client to report which of the following findings immediately? (Select all that apply.)