The nurse is preparing to administer warfarin sodium 10 mg PO to a client whose international normalized ratio (INR) is 5.0. Which intervention should the nurse implement?
Reference Range:
International 1 normalized ratio (INR) [INR: 0.8 to 1.1]
Administer the scheduled dose.
Discontinue the warfarin schedule.
Withhold warfarin for 24 hours
Obtain another INR analysis immediately.
The Correct Answer is C
A) Administer the scheduled dose: Administering the scheduled dose of warfarin when the INR is 5.0 is not appropriate because this INR level is significantly elevated, indicating a high risk of bleeding. Warfarin dosing should be adjusted based on INR levels to prevent complications such as excessive bleeding.
B) Discontinue the warfarin schedule: Completely discontinuing warfarin may not be necessary unless there are additional factors or signs of bleeding. It is essential to take appropriate action based on the INR level, but discontinuation should be guided by further evaluation and healthcare provider recommendations.
C) Withhold warfarin for 24 hours: Withholding the dose of warfarin is the correct action when faced with an elevated INR of 5.0. This intervention is crucial to prevent potential bleeding complications while waiting for further evaluation and guidance from the healthcare provider regarding additional management, such as administration of vitamin K or other reversal agents.
D) Obtain another INR analysis immediately: While obtaining another INR analysis can be helpful in monitoring trends, it is not the immediate priority if the INR is already 5.0. The primary action should be to withhold the dose and consult with the healthcare provider to determine the appropriate next steps for managing the elevated INR and ensuring patient safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Reduce caffeine and acidic intake: This is appropriate advice as caffeine and acidic foods can potentially affect uric acid levels and might exacerbate gout symptoms.
B. Double the dose if a dose is missed: This is incorrect and requires additional instruction. Allopurinol should not be doubled if a dose is missed. Instead, the missed dose should be taken as soon as possible unless it is almost time for the next dose. Doubling the dose could lead to increased risk of side effects or adverse reactions.
C. Avoid taking on an empty stomach: This is generally good advice, although allopurinol can be taken with or without food. Taking it with food might help reduce potential gastrointestinal discomfort.
D. Consume 2 liters of water daily: This is recommended to help prevent the formation of uric acid crystals and to ensure adequate hydration, which is beneficial while on allopurinol.
Correct Answer is C
Explanation
A) Increases contractility: Metoprolol, a beta-blocker, actually decreases contractility. It reduces the force of contraction of the heart muscle, which can help reduce myocardial oxygen demand and improve outcomes after ACS. Increasing contractility would counteract the therapeutic goals of metoprolol in managing ACS.
B) Increases preload: Preload refers to the volume of blood in the ventricles at the end of diastole. Metoprolol does not increase preload; rather, it reduces myocardial workload and oxygen demand, which does not directly affect preload but rather the heart's performance overall.
C) Decreases afterload: Metoprolol reduces afterload indirectly by lowering blood pressure and decreasing heart rate, which helps reduce the workload on the heart. This reduction in afterload supports the therapeutic goals of metoprolol in managing ACS by decreasing the heart's work and improving cardiac efficiency.
D) Decreases diastolic filling time: Metoprolol slows the heart rate, which can lead to increased diastolic filling time, not a decrease. Increased filling time can be beneficial as it allows the heart more time to fill with blood between beats, thereby improving cardiac output.
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