A nurse is preparing a client for discharge home after an admission for bilateral pulmonary emboli. The client is prescribed warfarin in addition to regular daily medications. Which of the following actions should the nurse take?
Advise the client that over-the-counter medications remain safe to consume as needed.
Consult the pharmacist about potential interactions between the client’s regular medications and warfarin.
Recommend the client take warfarin at the same time as other medications.
Tell the client they can continue to drink cranberry juice while taking warfarin.
The Correct Answer is B
Choice A reason: Advising over-the-counter medications as safe is incorrect, as many, like NSAIDs, increase warfarin’s bleeding risk by inhibiting platelets or affecting liver metabolism. Warfarin’s narrow therapeutic index requires careful management to prevent hemorrhage, making broad safety claims dangerous without specific evaluation.
Choice B reason: Consulting the pharmacist identifies interactions with warfarin, a vitamin K antagonist metabolized by CYP450 enzymes. Many drugs alter warfarin’s efficacy, risking thrombosis or bleeding. Pharmacist expertise ensures safe polypharmacy, maintaining therapeutic INR levels critical for managing pulmonary emboli effectively.
Choice C reason: Recommending warfarin with other medications ignores interaction risks and timing needs. Warfarin’s absorption is unaffected by timing, but CYP450 interactions can alter INR. This advice is irrelevant to safety, missing the need for individualized regimen assessment to prevent complications in anticoagulation therapy.
Choice D reason: Cranberry juice may enhance warfarin’s effect by inhibiting CYP2C9, increasing INR and bleeding risk. Advising its use without monitoring is unsafe, as dietary factors can destabilize anticoagulation, potentially causing hemorrhage in clients with pulmonary emboli, requiring careful dietary guidance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Fibromyalgia, a chronic pain condition, is not a contraindication for oral contraceptives. Estrogen and progesterone do not exacerbate fibromyalgia’s musculoskeletal or neurological symptoms, as they primarily affect hormonal pathways, making contraceptives safe for use in clients with this condition.
Choice B reason: Hypertension is a contraindication for oral contraceptives, as estrogen increases renin-angiotensin activity, elevating blood pressure. This risks cardiovascular events like stroke or myocardial infarction, especially in clients with existing hypertension, necessitating alternative contraception to avoid vascular complications.
Choice C reason: Iron-deficiency anemia is not a contraindication, as oral contraceptives may reduce menstrual bleeding, improving anemia by decreasing iron loss. Their hormonal effects do not impact erythropoiesis, making them potentially beneficial for anemic clients, unlike hypertension, which poses risks.
Choice D reason: Human papillomavirus (HPV) is not a contraindication, as it affects cervical epithelium, not hormonal pathways. While some studies suggest a weak link to cervical cancer, HPV vaccination and screening mitigate risks, making oral contraceptives safe for clients with HPV.
Correct Answer is D
Explanation
Choice A reason: Bleeding time assesses platelet function, not warfarin’s anticoagulant effect. Warfarin inhibits vitamin K-dependent clotting factors, unrelated to platelets. Monitoring bleeding time does not reflect therapeutic anticoagulation levels, making it irrelevant for adjusting warfarin doses to prevent thrombosis or bleeding.
Choice B reason: Factor VIII, deficient in hemophilia A, is not affected by warfarin, which targets vitamin K-dependent factors (II, VII, IX, X). Measuring Factor VIII does not indicate warfarin’s efficacy, as it is unrelated to the drug’s mechanism, making it unsuitable for dose monitoring.
Choice C reason: aPTT monitors heparin’s effect on the intrinsic clotting pathway, not warfarin’s action on vitamin K-dependent factors. Warfarin requires INR for therapeutic monitoring, as aPTT is insensitive to its effects, making it inappropriate for assessing warfarin’s anticoagulation range in patients.
Choice D reason: INR standardizes prothrombin time, measuring warfarin’s effect on vitamin K-dependent clotting factors. It ensures therapeutic anticoagulation (e.g., INR 2-3), preventing thrombosis or bleeding. INR is the gold standard for warfarin monitoring, guiding dose adjustments for safe and effective therapy.
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