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A nurse is providing education for client newly prescribed warfarin in preparation for being discharged home. Which of the following should be included the teaching plan? (Select all that apply.)

You may start taking warfarin while still on Heparin when you are getting ready be discharged home

You will need to have your aPTT monitored frequently while on Warfarin

Use a soft-bristled toothbrush and avoid brushing too aggressively

You should replace straight razors with an electric shaver to avoid cuts

Increase foods high in vitamin K like dark green leafy vegetables, while taking

Answer and Explanation

Correct Answer : A,C,D

The correct answers are:

A. You may start taking warfarin while still on heparin when you are getting ready to be discharged home.

Warfarin takes several days to reach therapeutic levels, so patients often overlap with heparin until the INR (International Normalized Ratio) reaches the target range (typically 2.0-3.0 for most conditions).

C. Use a soft-bristled toothbrush and avoid brushing too aggressively.

Warfarin increases the risk of bleeding, so using a soft toothbrush helps prevent gum bleeding.

D. You should replace straight razors with an electric shaver to avoid cuts.

Since warfarin thins the blood, small cuts can lead to excessive bleeding. An electric shaver reduces the risk of accidental cuts.

B. You will need to have your aPTT monitored frequently while on Warfarin. (Incorrect)

Warfarin is monitored using INR and PT (Prothrombin Time), not aPTT.
aPTT (Activated Partial Thromboplastin Time) is used to monitor heparin therapy, not warfarin.

E. Increase foods high in vitamin K like dark green leafy vegetables while taking Warfarin. (Incorrect)

Vitamin K counteracts warfarin's effects, so patients should keep their vitamin K intake consistent rather than increasing it.

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Correct Answer is A

Explanation

A) Obtain samples for urine culture and urinalysis:
This is the first priority. The symptoms described—urinary frequency, dysuria (painful urination), and fever—are suggestive of a urinary tract infection (UTI). To confirm the diagnosis and identify the causative organism, it is critical to obtain a urine sample for both a urinalysis and urine culture. The culture will help guide antibiotic therapy once the organism is identified. This is the foundational step before initiating any treatment. The results will also help determine whether the infection is localized or more severe, like a pyelonephritis
or systemic infection.

B) Insert a Foley catheter:
Inserting a Foley catheter may be necessary if the patient is unable to void, but it is not the first intervention in this case. A Foley catheter is generally used for urinary retention or if monitoring of urine output is necessary. In the context of suspected UTI symptoms, a Foley catheter should only be inserted if there is a clear need, not just for the convenience of obtaining a sample. Additionally, inserting a Foley catheter could introduce bacteria if the patient is not already catheterized and should therefore be avoided unless medically indicated.

C) Begin broad-spectrum IV antibiotics:
While starting antibiotics is important in treating a suspected UTI, especially in the presence of fever and potential infection, obtaining a urine sample for culture and urinalysis should be done first. This allows the healthcare team to tailor antibiotic therapy based on the culture results, reducing the risk of unnecessary or incorrect antibiotic use. If the patient is febrile and appears severely ill, broad-spectrum antibiotics may be started after obtaining the urine sample, but the culture and urinalysis must still be prioritized.

D) Prepare the client for a CT scan:
While imaging studies like a CT scan may be helpful in evaluating for complications, they are not the first step in managing the patient’s symptoms. Obtaining the urine sample and identifying whether an infection is present is essential for guiding further management. A CT scan may be ordered later if the clinical suspicion for complications remains high after the initial evaluation and lab results.

A. Diarrhea, possibly containing blood. B. Increased risk for colorectal cancer. C. Skip lesions and cobblestone appearance D. Risk for bowel perforation and toxic megacolon

Correct Answer is C

Explanation

A) Diarrhoea, possibly containing blood: Diarrhea, often accompanied by blood, is a hallmark symptom of ulcerative colitis. The inflammation typically starts in the rectum and extends proximally, causing frequent, bloody diarrhea. This symptom is a defining characteristic of the condition and is indicative of active disease.

B) Increased risk for colorectal cancer: Ulcerative colitis, especially when it is chronic or poorly controlled, significantly increases the risk for colorectal cancer. This is due to long-term inflammation that can cause cellular changes in the colon over time. Regular screenings are recommended for individuals with a history of ulcerative colitis.

C) Skip lesions and cobblestone appearance: This is the exception. Skip lesions and a cobblestone appearance are characteristic of Crohn's disease, not ulcerative colitis. Crohn's disease can affect any part of the gastrointestinal tract and often exhibits areas of healthy tissue interspersed with areas of inflammation, known as skip lesions. Ulcerative colitis, in contrast, involves continuous inflammation that typically starts in the rectum and progresses proximally without the skip pattern.

D) Risk for bowel perforation and toxic megacolon: Both bowel perforation and toxic megacolon are complications associated with ulcerative colitis, particularly during severe flare-ups. Toxic megacolon is a life-threatening condition where the colon becomes massively dilated and can rupture, leading to peritonitis. This is a known risk with severe or poorly managed ulcerative colitis.

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A nurse is providing education for client newly prescribed warfarin in preparation for being discharged home. Which of the following should be included the teaching plan? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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