Which of the following would be included in bleeding precautions for a client taking warfarin? SELECT ALL THAT APPLY
Use soft bristled tooth brush
Report black or bloody bowel movements
Limit all fruits and vegetables
Report coffee ground or bloody emesis
Shave with electric razor instead of razor blade
Correct Answer : A,B,D,E
Choice A reason: Using a soft bristled tooth brush can prevent gum bleeding and irritation that may occur with a hard bristled tooth brush. Gum bleeding can be a sign of excessive anticoagulation and increased risk of bleeding.
Choice B reason: Reporting black or bloody bowel movements is important because it can indicate gastrointestinal bleeding, which can be a serious complication of warfarin therapy. Gastrointestinal bleeding can cause anemia, shock, and even death if not treated promptly.
Choice C reason: Limiting all fruits and vegetables is not necessary for a client taking warfarin. However, some fruits and vegetables, especially those that are high in vitamin K, can interfere with the effect of warfarin and increase the risk of clotting. Vitamin K is found in green leafy vegetables, such as spinach, kale, broccoli, and cabbage, and some fruits, such as avocado, kiwi, and grapes. The client should maintain a consistent intake of vitamin K and avoid sudden changes in their diet.
Choice D reason: Reporting coffee ground or bloody emesis is also important because it can indicate upper gastrointestinal bleeding, which can be another serious complication of warfarin therapy. Upper gastrointestinal bleeding can cause hematemesis, melena, anemia, and hypovolemic shock.
Choice E reason: Shaving with an electric razor instead of a razor blade can prevent skin cuts and bleeding that may occur with a razor blade. Skin cuts and bleeding can be a sign of excessive anticoagulation and increased risk of bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["2.8"]
Explanation
Convert the patient's weight from pounds to kilograms:
154 lb ÷ 2.2 = 70 kg
Calculate the dose of pentamidine:
4 mg/kg × 70 kg = 280 mg
Determine the volume to be administered:
We have 100 mg/mL concentration of pentamidine.
280 mg ÷ 100 mg/mL = 2.8 mL
Therefore, the nurse should administer 2.8 mL of pentamidine to the client.
Correct Answer is ["150"]
Explanation
To calculate the IV pump rate for the 0.9% sodium chloride 1,200 mL IV to infuse over 8 hours, we can use the following formula:
IV pump rate (mL/hr) = Total volume (mL) / Time (hr)
Using the given values:
Total volume = 1,200 mL
Time = 8 hours
Plugging these values into the formula:
IV pump rate = 1,200 mL / 8 hr
IV pump rate = 150 mL/hr
So, the nurse should set the IV pump to deliver 150 mL/hr to infuse the 1,200 mL of 0.9% sodium chloride over 8 hours.
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