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

Answer and Explanation

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.

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Correct Answer is D

Explanation

A. Most CAM therapies are not totally ineffective: While some CAM therapies may lack strong scientific evidence, it's not accurate to say they are all ineffective. Some CAM therapies may have benefits, but it's important to be aware of them to avoid interactions.

B. Not all CAM therapies are dangerous: Many CAM therapies are generally safe. However, some can interact with medications or have unforeseen side effects, so assessing use is crucial.

C. Additional treatment may still be needed: Even if a patient uses CAM, they might still require conventional medical treatment. Assessing CAM use helps ensure a complete picture of the patient's healthcare regimen.

D. CAM therapies could interact with prescription and OTC medications. Correct. The primary reason to assess CAM use is to identify potential interactions with medications, potentially improving patient safety and treatment effectiveness.

A. Platelets 74,000/mm3 B. White blood cell count 8,000/mm3 C. Partial thromboplastin time (PTT) 55 seconds D. Hematocrit 45%

Correct Answer is A

Explanation

A. Platelets 74,000/mm: A platelet count of 74,000/mm³ is significantly lower than the normal range (typically 150,000 to 450,000/mm³). This could indicate heparin-induced thrombocytopenia (HIT), a serious adverse effect of heparin therapy where the immune system forms antibodies against heparin bound to platelet factor 4, leading to a decrease in platelets and increased risk of thrombosis. This is a critical finding and should be reported immediately to the provider for further evaluation and potential adjustment of the treatment plan.

B. White blood cell count 8,000/mm³: This is within the normal range (typically 4,000 to 11,000/mm³) and does not indicate an immediate problem related to heparin therapy or pulmonary embolism management.

C. Partial thromboplastin time (PTT) 55 seconds: While slightly elevated, this PTT is within the therapeutic range for a patient receiving IV heparin (typically 1.5 to 2.5 times the normal control value, or about 45 to 70 seconds). This indicates that the heparin is having the desired anticoagulant effect.

D. Hematocrit 45%: This is within the normal range for adults (typically 38-50% for men and 35-45% for women) and does not indicate an immediate concern related to heparin therapy or pulmonary embolism.

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Naxlex Comprehensive Predictor Exams

It is important for the nurse to assess for the use of complementary and alternative medicine (CAM) because:

Correct Answer is D

Explanation

A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider?

Correct Answer is A

Explanation

A nurse is preparing to administer digoxin 0.25 mg PO to a client. The amount available is digoxin 0.125 mg tablets. How many tablets should the nurse administer to the client? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

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A nurse is collecting data from a client who has a prosthetic aortic valve and takes warfarin daily at bedtime. Which of the following data is the priority finding for the nurse to report to the provider?

A patient has started taking clopidogrel (Plavix) after experiencing a transient ischemic attack. What adverse effects are associated with this drug? (Select all that apply)

When beginning herbal products, the nurse understands that the best way to identify allergic or other adverse reactions is to have the client:

The nurse responds to the client's questions about CAM therapies and explains that some have been popular for centuries in treating conditions of the body and mind including which of the following? (Select All that Apply.)

A nurse is collecting data from a client who is receiving clopidogrel following the placement of a cardiac stent. Which of the following findings should the nurse identify as an adverse effect of this medication?