A nurse is caring for a patient who is newly diagnosed with deep vein thrombosis and has been on a continuous heparin infusion for 3 days. The provider prescribes oral warfarin without discontinuing the heparin. The patient asks why both drugs are necessary. What is the appropriate response by the nurse?

A "Warfarin takes several days to work, so the heparin will be used until the warfarin reaches a therapeutic level."

"The heparin increases the effects of the warfarin and decreases the length of your hospital stay."

"I will call the provider to discontinue the heparin."

"Both medications work together to dissolve the clots."

Answer and Explanation

The Correct Answer is A

A. "Warfarin takes several days to work, so the heparin will be used until the warfarin reaches a therapeutic level":
This response is correct because warfarin, an oral anticoagulant, takes several days to reach its full therapeutic effect due to its mechanism of action on vitamin K-dependent clotting factors. Therefore, heparin, which has an immediate onset of action, is used concurrently to prevent new clot formation until warfarin reaches therapeutic levels. Once warfarin reaches its therapeutic range, heparin is typically discontinued.

B. "The heparin increases the effects of the warfarin and decreases the length of your hospital stay":
This statement is incorrect. While heparin and warfarin both act as anticoagulants, they have different mechanisms of action. Heparin works rapidly by inhibiting thrombin, while warfarin acts more slowly by inhibiting vitamin K-dependent clotting factors. The concurrent use of heparin and warfarin is not to increase the effects of warfarin but rather to bridge the gap until warfarin reaches therapeutic levels.

C. "I will call the provider to discontinue the heparin":
Discontinuing heparin without a clear order from the provider could be inappropriate and potentially dangerous. Abrupt discontinuation of heparin before warfarin reaches therapeutic levels could increase the risk of thrombus formation or embolization. The decision to discontinue heparin should be made by the provider based on the patient's individual clinical status and response to therapy.

D. "Both medications work together to dissolve the clots":
While both heparin and warfarin are anticoagulants used to prevent further clot formation and propagation, they do not directly dissolve existing clots. Instead, they prevent the formation of new clots and allow the body's natural fibrinolytic system to gradually break down existing clots. Therefore, this statement is not entirely accurate in describing the mechanism of action of these medications.

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Correct Answer is B

Explanation

A. Diarrhea: Diarrhea is not a common side effect of metoprolol, a beta-blocker medication commonly used to treat hypertension. While gastrointestinal side effects such as nausea or constipation may occur, diarrhea is not typically associated with metoprolol use.

B. Insomnia: Insomnia, or difficulty falling or staying asleep, is a potential side effect of metoprolol. Beta-blockers like metoprolol may interfere with sleep patterns in some individuals, leading to insomnia. It is important for the nurse to assess the patient for changes in sleep patterns while taking metoprolol.

C. Urinary retention: Urinary retention, or the inability to completely empty the bladder, is not a common side effect of metoprolol. In fact, beta-blockers like metoprolol are more likely to cause urinary frequency or urgency rather than retention.

D. Gum changes: Gum changes, such as gingival hyperplasia, are not typically associated with metoprolol use. This side effect is more commonly associated with certain other medications, such as calcium channel blockers or anticonvulsants.

A. Drink purified water B. Avoid crowded, enclosed spaces C. Complete the vaccination series D. Avoid sharing utensils

Correct Answer is C

Explanation

A. Drink purified water: While drinking purified water is important for preventing various waterborne diseases, it is not a preventive measure specifically targeted at hepatitis B virus (HBV) transmission. HBV is primarily transmitted through exposure to infected blood or body fluids, such as during unprotected sex, sharing needles, or from mother to child during childbirth. Drinking purified water does not protect against these modes of HBV transmission.

B. Avoid crowded, enclosed spaces: Avoiding crowded, enclosed spaces may reduce the risk of respiratory infections, but it does not specifically prevent HBV transmission. HBV is not transmitted through the air like respiratory viruses. Instead, it is spread through direct contact with infected blood or body fluids. While avoiding crowded spaces may be a general infection control measure, it is not a targeted preventive measure for HBV.

C. Complete the vaccination series: This is the correct preventive measure for HBV. The hepatitis B vaccine is highly effective in preventing HBV infection. It is administered as a series of shots, typically given in three doses over a period of several months. Completing the vaccination series provides long-term immunity against HBV infection and is recommended for all individuals, including travelers to regions where HBV is common. Vaccination not only protects the individual but also contributes to reducing the overall prevalence of HBV in the community.

D. Avoid sharing utensils: While avoiding sharing utensils can reduce the risk of transmitting certain infections, such as colds or flu, it is not specifically aimed at preventing HBV transmission. HBV is primarily transmitted through activities involving exposure to infected blood or body fluids, rather than through sharing utensils. While practicing good hygiene and avoiding behaviors that may result in exposure to blood or body fluids are important preventive measures for HBV, completing the vaccination series is the most effective way to prevent infection.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient who has been taking metoprolol as a second medication to control hypertension. The nurse will assess for which side effect?

Correct Answer is B

Explanation

A nurse is conducting a health education about viral hepatitis B (HBV)in a community setting. An individual plans to travel to a country where hepatitis B is common. What will the nurse teach is the only preventive measure for HBV?

Correct Answer is C

Explanation

The nurse is assessing a patient who is complaining of blurred vision. The patient's blood pressure reading is 195/130, the heart rate is 95 beats per minute. Which assessment finding by the nurse is consistent with a diagnosis of hypertensive emergency?

The nurse is assessing a patient with chronic hypertension whose blood pressure has been 160/90 for the last three clinic visits. What new symptom indicates that the patient may be experiencing target organ damage?

A nurse is assessing a patient who has a history of human immunodeficiency virus (HIV) and has been admitted with pneumonia. Which intervention will the nurse perform to ensure the patient exhibits clear breath sounds?

The nurse is teaching a patient, newly diagnosed with primary hypertension, about the recommended blood pressure range needed to prevent organ damage. Which range, chosen by patient, indicates that the teaching was successful?

The nurse is reviewing the lab results of a patient who takes warfarin to prevent deep vein thrombosis. Which laboratory result requires follow up by the nurse?

The nurse is caring for a patient diagnosed with acquired immunodeficiency syndrome (AIDS) whose most recent laboratory values reveal a CD4 level less than 200. Which assessment findings require immediate intervention?

A patient taking an angiotensin receptor blocker (AR) to control blood pressure is now complaining of muscle cramps which action will the nurse implement?