A patient is receiving warfarin (Coumadin), which is 98% bound to plasma proteins. The antidepressant paroxetine (Paxil), which is 95% bound to plasma proteins, is added to the patient's daily medication. If the paroxetine displaces warfarin from its protein binding sites, which of the following will most likely to occur?
Diminished effect from warfarin
Diminished effect from paroxetine
Increased effect, and toxicity from paroxetine
Increased effect, and toxicity from warfarin
The Correct Answer is D
A. Diminished effect from warfarin: This is unlikely because displacement of warfarin from protein binding sites would increase its concentration in the bloodstream, potentially leading to increased anticoagulant effects and toxicity.
B. Diminished effect from paroxetine: This is also unlikely because displacement of paroxetine from protein binding sites would increase its concentration in the bloodstream, potentially leading to increased pharmacological effects and toxicity.
C. Increased effect, and toxicity from paroxetine: If paroxetine displaces warfarin from protein binding sites, it can increase the concentration of free warfarin in the bloodstream, leading to increased anticoagulant effects and potential toxicity.
D. Increased effect, and toxicity from warfarin: Correct. If warfarin is displaced from protein binding sites by paroxetine, it can increase the concentration of free warfarin in the bloodstream, leading to increased anticoagulant effects and potential toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Easy bruising indicates the medication is effective: While some bruising is possible, excessive bruising doesn't necessarily mean the medication is working effectively. It could indicate excessive anticoagulation, requiring dose adjustments.
B. Inject the medication deep into the thigh muscle: Heparin is injected subcutaneously, targeting the fatty tissue layer just beneath the skin. Injecting into the muscle can be painful and decrease absorption.
C. Expect stools to become black and tarry: Black stools can be a sign of upper gastrointestinal bleeding, a potential but uncommon side effect. The nurse should instruct the client to report any black stools but not expect them as a normal occurrence.
D. Use a soft bristle toothbrush: This is important because heparin increases bleeding risk, and a soft-bristled toothbrush minimizes gum irritation and potential bleeding.
Correct Answer is ["6.0"]
Explanation
To find the volume of amoxicillin solution the nurse needs to administer, we can divide the desired dose (300 mg) by the concentration of the solution (250 mg/5 mL).
Here's the calculation:
Amoxicillin volume (mL) = Desired dose (mg) / Concentration (mg/mL) Amoxicillin volume (mL) = 300 mg / 250 mg/5 mL
Since we're dividing by a fraction, it's mathematically equivalent to multiply by the reciprocal of the fraction. The reciprocal of 250 mg/5 mL is 5 mL/250 mg.
Amoxicillin volume (mL) = 300 mg * (5 mL / 250 mg)
Cancel out the milligrams (mg) units:
Amoxicillin volume (mL) = 300 mg / 250 mg * 5 mL
Amoxicillin volume (mL) = 1.2 mL (rounded to one decimal place)
However, since we are dealing with medication, it's best to round to the nearest whole number for accuracy in administering the dose.
Therefore, the nurse should administer 6.0 mL of amoxicillin oral solution.
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