A nurse is reviewing the medical history of a client who asks about the use of warfarin.
The nurse should identify which of the following findings as a contraindication for the administration of this medication?

Recent myocardial infarction.

Recent eye surgery.

Thrombophlebitis.

Breast cancer.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Recent myocardial infarction is not a contraindication for warfarin administration. Warfarin is often prescribed for patients with a history of myocardial infarction to prevent clot formation and reduce the risk of stroke.

Choice B rationale:

Recent eye surgery is a contraindication for the administration of warfarin. Warfarin can increase the risk of bleeding, which is particularly concerning after eye surgery due to the delicate nature of ocular tissues. Using anticoagulants in this scenario can lead to severe complications, including vision loss.

Choice C rationale:

Thrombophlebitis, inflammation of a vein with clot formation, is not a contraindication for warfarin administration. In fact, anticoagulants like warfarin are commonly prescribed to prevent the extension of clots and reduce the risk of complications associated with thrombophlebitis.

Choice D rationale:

Breast cancer is not a direct contraindication for warfarin administration. However, the decision to use anticoagulants in patients with a history of breast cancer should be made carefully, considering individual factors such as the stage of cancer, ongoing treatment, and overall risk of thromboembolic events.

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Correct Answer is D

Explanation

The correct answer isChoice D, remove the protective gown while in the client’s room.

Choice A rationale: Wearing a face shield is not specifically required for Clostridium difficile infection (CDI) precautions. CDI is primarily spread through the fecal-oral route, and while a face shield could provide protection against splashes during procedures that might generate them, it is not a standard precaution for entering the room of a patient with CDI.

Choice B rationale: Placing a mask on the client during transport is not a standard precaution for CDI. While it is important to prevent the spread of infection, CDI is not transmitted through the respiratory route, so a mask for the client would not be necessary in this context.

Choice C rationale: Using an alcohol-based hand rub is generally recommended for hand hygiene. However, for CDI, alcohol-based hand rubs are not effective against C. difficile spores. The Centers for Disease Control and Prevention (CDC) recommends washing hands with soap and water after caring for patients with CDI to physically remove the spores from the hands.

Choice D rationale: Removing the protective gown while still in the client’s room is the correct action to prevent the spread of contamination. Gowns should be removed before leaving the patient’s room to avoid dispersing contaminants to other areas of the healthcare facility.

Infection control for CDI involves several specific actions due to the resilience of C. difficile spores. These spores can survive on surfaces for a long time and are resistant to many common disinfectants, which is why environmental cleaning and disinfection with agents effective against C. difficile, such as bleach-based products, are crucial. Additionally, healthcare workers should use gloves and gowns when entering the rooms of patients with CDI and should ensure that these are disposed of correctly after use.

A. Sun protection is not necessary when using self-tanning creams. B. The risk of injury from firearms decreases as children enter adolescence. C. Driving skills can be impaired when friends are present. D. Medroxyprogesterone provides protection against gonorrhea.

Correct Answer is C

Explanation

Choice A rationale:

Sun protection is necessary when using self-tanning creams. These products do not provide protection against harmful UV rays. Failure to use sun protection measures, such as sunscreen and protective clothing, can lead to skin damage and increase the risk of skin cancer.

Choice B rationale:

The risk of injury from firearms does not necessarily decrease as children enter adolescence. Adolescents, like any other age group, should be educated about the dangers of firearms and the importance of firearm safety. Access to firearms should be restricted, and proper storage and education about safe handling are essential.

Choice C rationale:

Driving skills can be impaired when friends are present, especially for new and inexperienced drivers. Peer pressure and distractions from friends can lead to risky behaviors and impaired judgment, increasing the risk of accidents. It is crucial to educate adolescents about the importance of focused and responsible driving.

Choice D rationale:

Medroxyprogesterone is a hormonal contraceptive and does not provide protection against gonorrhea or other sexually transmitted infections (STIs). Safe sex practices, including the use of barrier methods such as condoms, are essential in preventing the transmission of STIs.

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A nurse is reviewing the medical history of a client who asks about the use of warfarin.The nurse should identify which of the following findings as a contraindication for the administration of this medication?

Nursing Test Bank

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A nurse is reviewing the medical history of a client who asks about the use of warfarin.
The nurse should identify which of the following findings as a contraindication for the administration of this medication?