The nurse is caring for a patient with atrial fibrillation who has been prescribed warfarin (Coumadin). The patient’s INR level is 3.5, which is above therapeutic range. What action should the nurse take?

Administer vitamin K as ordered by physician

Administer heparin as ordered by physician

Administer warfarin as ordered by physician

Hold warfarin and notify physician.

Answer and Explanation

The Correct Answer is D

Warfarin is an anticoagulant that prevents blood clots from forming or growing larger. It works by inhibiting the synthesis of vitamin K-dependent clotting factors in the liver. The INR (international normalized ratio) is a measure of how long it takes the blood to clot. The therapeutic range for INR depends on the indication for warfarin therapy, but for atrial fibrillation, it is usually between 2 and 3. An INR level of 3.5 is above the therapeutic range, which means the blood is too thin and the patient is at risk of bleeding. The nurse should hold the warfarin dose and notify the physician, who may order vitamin K to reverse the effects of warfarin.

Choice A) Administer vitamin K as ordered by physician is wrong because vitamin K is not indicated unless the physician orders it based on the patient’s condition and INR level.

Vitamin K is an antidote for warfarin overdose and can reverse its anticoagulant effects.

However, administering vitamin K without a physician’s order may cause the INR to drop below the therapeutic range and increase the risk of clotting.

Choice B) Administer heparin as ordered by physician is wrong because heparin is another anticoagulant that works by activating antithrombin, a natural inhibitor of clotting factors.

Heparin is used for acute treatment of thromboembolic disorders, such as deep vein thrombosis or pulmonary embolism.

It is not indicated for atrial fibrillation unless there is evidence of acute thrombosis.

Administering heparin to a patient with an elevated INR would increase the risk of bleeding.

Choice C) Administer warfarin as ordered by physician is wrong because warfarin is the cause of the elevated INR and should be withheld until the INR returns to the therapeutic range.

Continuing to administer warfarin would further increase the INR and the risk of bleeding.

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Correct Answer is A

Explanation

Mannitol is an osmotic diuretic that increases urine output and decreases intracranial pressure and intraocular pressure. The nurse should check the urine output before giving the medication to ensure adequate renal function and prevent fluid overload and electrolyte imbalance. The normal urine output is 0.5 to 1 mL/kg/hr.

Choice B is wrong because checking the blood pressure is not specific to mannitol administration. Mannitol can cause hypotension or hypertension depending on the fluid status of the client, but this is not the priority action before giving the medication.

Choice C is wrong because checking the blood glucose is not relevant to mannitol administration. Mannitol does not affect blood glucose levels.

Choice D is wrong because checking the oxygen saturation is not related to mannitol administration. Mannitol does not affect oxygen saturation levels.

A. Beta blockers B. Calcium channel blockers C. Angiotensin II receptor blockers (ARBs) D. Direct acting vasodilators.

Correct Answer is C

Explanation

Angiotensin II receptor blockers (ARBs) block the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects

Choice A is wrong because beta blockers do not block angiotensin II receptors, but rather beta-adrenergic receptors, which are involved in the sympathetic nervous system.Beta blockers reduce heart rate and blood pressure by inhibiting the effects of adrenaline and noradrenaline

Choice B is wrong because calcium channel blockers do not block angiotensin II receptors, but rather calcium channels, which are involved in the contraction of smooth muscle cells.Calcium channel blockers relax blood vessels and lower blood pressure by reducing the influx of calcium into the cells

Choice D is wrong because direct acting vasodilators do not block angiotensin II receptors, but rather act directly on the smooth muscle cells of blood vessels, causing them to relax and dilate.Direct acting vasodilators lower blood pressure by decreasing peripheral resistance

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The nurse is caring for a patient with atrial fibrillation who has been prescribed warfarin (Coumadin). The patient’s INR level is 3.5, which is above therapeutic range. What action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning to administer mannitol to a client who has heart failure and pulmonary edema. Which of the following actions should the nurse take before giving the medication?

Correct Answer is A

Explanation

Which drug blocks the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects?

Correct Answer is C

Explanation

A nurse is evaluating a client who has hypertension and is taking lisinopril, an angiotensin II receptor blocker (ARB). Which of the following outcomes indicates that the medication is effective?

The nurse is caring for a patient with atrial fibrillation who has been prescribed warfarin (Coumadin). The patient’s INR level is 3.5, which is above therapeutic range. What action should the nurse take?

A nurse is teaching a client who has hypertension and is prescribed nifedipine, a calcium channel blocker, about self-care measures. Which of the following instructions should the nurse include? (Select all that apply.)

Which drugs act on the sympathetic nervous system, which regulates blood pressure by controlling heart rate, cardiac output, vascular tone, and renin release?

A nurse is evaluating a client who has heart failure and is receiving warfarin. Which of the following statements by the client indicates a need for further teaching?

A patient with atrial fibrillation has been prescribed digoxin (Lanoxin). The nurse should monitor which laboratory value to evaluate therapeutic effectiveness?

A nurse is caring for a client who has heart failure and is receiving carvedilol (Coreg). The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness of this medication?

A nurse is caring for a client who has heart failure and is receiving digoxin (Lanoxin). The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness of this medication?