A nurse is teaching a client who has a prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching?
"I should use a hard bristle toothbrush."
"I should get my INR checked once a year."
"I should not take a St. John's wort supplement."
"I should not eat cantaloupe while taking the medication."
The Correct Answer is C
Warfarin is a Vitamin K antagonist that interferes with the synthesis of clotting factors II, VII, IX, and X. It has a narrow therapeutic window and is subject to numerous cytochrome P450 interactions with herbal supplements and foods. Maintaining a consistent intake of Vitamin K and avoiding platelet-inhibiting substances is vital to prevent hemorrhage or thromboembolic events.
Rationale:
A. Using a hard bristle toothbrush is incorrect because warfarin therapy increases the risk of gingival bleeding due to impaired coagulation. Clients are instructed to use a soft-bristle toothbrush to minimize trauma to the oral mucosa and prevent bleeding episodes. Any source of mechanical irritation can lead to significant hemorrhage in a patient who is therapeutically anticoagulated.
B. Getting an INR checked once a year is dangerously infrequent for a patient on warfarin therapy. The International Normalized Ratio (INR) must be monitored every few days when starting therapy and at least monthly once a stable dose is established. Frequent monitoring is necessary to adjust the dosage and ensure the patient stays within the therapeutic range of 2.0 to 3.0.
C. St. John's wort is a potent inducer of hepatic enzymes that significantly increases the metabolism of warfarin, leading to subtherapeutic levels. If the client takes this supplement, they are at a much higher risk of developing dangerous blood clots or suffering a stroke. Avoiding this herbal interaction indicates the client understands how to maintain the effectiveness of their anticoagulant.
D. Eating cantaloupe is generally safe for patients on warfarin as it does not contain high levels of Vitamin K that would interfere with the medication. The client should instead be taught to maintain a consistent intake of dark, leafy green vegetables like spinach or kale. Restricting fruits like cantaloupe is an unnecessary dietary limitation that does not affect the drug's efficacy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["15"]
Explanation
Step 1 is to identify the ordered dose per kg, the client's weight in kg, and the available concentration
Ordered Dose: 30 mg/kg
Client weight: 20 kg
Available Concentration: 200 mg / 5 mL
Step 2 is to calculate the total dose in milligrams (mg) required for the child
Total mg dose = weight in kg × dosage (mg/kg)
Total mg dose = 20 × 30
20 × 30 = 600
Total mg dose = 600 mg
Step 3 is to calculate the volume to administer in milliliters (mL)
Volume = (Total mg dose ÷ Available dose) × Available volume
Volume = (600 ÷ 200) × 5
600 ÷ 200 = 3
3 × 5 = 15
Volume to administer = 15 mL
Step 4 is to round to the nearest whole number
15 = 15
Answer: 15 mL
Correct Answer is A
Explanation
Total parenteral nutrition (TPN) is a hypertonic solutiondelivered intravenously to provide complete nutritional support when the enteral route is non-functional. It contains a balance of amino acids, dextrose, lipids, electrolytes, and vitamins tailored to the patient's metabolic needs. TPN bypasses the gastrointestinal tract, preventing the need for mechanical digestionand nutrient absorption through the intestinal mucosa.
Rationale:
A.TPN is specifically designed to provide all necessary calories and nutrients intravenously, which allows for complete bowel rest. This is essential for patients with severe inflammatory bowel disease, fistulas, or intestinal obstructions where oral intake is impossible. By bypassing the gut, the inflamed or injured tissues have the opportunity to heal without the stress of digestion.
B.TPN does not contain medications that specifically improve the absorption capabilities of the digestive tract itself. Its primary function is to deliver pre-digested nutrients directly into the bloodstream, making intestinal absorption unnecessary. The goal is to provide systemic nutrition while the gut is bypassed, not to pharmacologically alter the intestinal wall's function.
C.TPN does not typically stimulate a client's appetite; in fact, the administration of high-calorie intravenous nutrition often decreases the sensation of hunger. Because the body's nutritional requirements are being met systemically, the physiological triggers for appetite may be suppressed. The purpose of TPN is to replace oral eating, not to encourage increased food consumption.
D.The primary purpose of TPN is nutritional support, not bowel cleansing or preparation for surgical procedures. While the bowels may become relatively empty because the patient is not eating, TPN is not an osmotic laxative or a clearing agent. Bowel clearing for surgery usually requires specific oral preparations or enemas rather than intravenous nutrition.
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