A 55-year-old male was admitted 1 week ago for a left lower leg venous thromboembolism, confirmed by ultrasound. He started to work from home 4 months ago and reports that his activity level has significantly decreased. When admitted, his left lower leg had 3+ edema and was warm and reddened over the calf area. He was immediately started on intravenous heparin therapy, with warfarin (Coumadin) on the same day. The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate?

Taking two medications dissolves the blood clot much faster.

Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner.

Heparin will start to dissolve the clot, and warfarin will prevent any more clots from forming.

Heparin works right away, but warfarin takes several days to prevent clots.

Answer and Explanation

The Correct Answer is D

Choice A reason: This statement is incorrect because the combination of heparin and warfarin does not dissolve the blood clot faster. Instead, these medications have different mechanisms of action. Heparin works quickly to prevent further clot formation, while warfarin takes several days to reach therapeutic levels and maintain anticoagulation over the long term.
Choice B reason: While the risk of a blood clot in the lungs (pulmonary embolism) is a concern, the necessity of using both heparin and warfarin is not because of the need for multiple blood thinners but rather due to their complementary pharmacokinetics. Heparin provides immediate anticoagulation, whereas warfarin requires time to become effective.
Choice C reason: This statement is also incorrect. Heparin does not dissolve clots but works to prevent the extension of existing clots and the formation of new ones. Warfarin, likewise, does not dissolve clots but prevents further clot formation by inhibiting vitamin K-dependent clotting factors.
Choice D reason: This is the accurate response. Heparin works immediately, providing rapid anticoagulation, which is essential for acute management of venous thromboembolism. On the other hand, warfarin takes several days to achieve its anticoagulant effect because it works by inhibiting the synthesis of vitamin K-dependent clotting factors. Therefore, the patient is initially placed on heparin to provide immediate protection against clotting while warfarin is started simultaneously. Once warfarin reaches a therapeutic level, heparin can be discontinued, and warfarin can maintain long-term anticoagulation.

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Correct Answer is ["A","C","E","F","G"]

Explanation

Choice A reason: Weight loss is indicative of hypermetabolism caused by excessive thyroid hormone production. The increased metabolic rate leads to higher energy consumption, resulting in unintentional weight loss even if the patient maintains or increases their food intake.
Choice B reason: Begins to cry when he tells you he recently lost his wife. Emotional responses, such as crying, can be associated with personal loss and grief but are not directly linked to hypermetabolism or excess thyroid hormone. This statement reflects the patient's emotional state rather than a physiological manifestation of hyperthyroidism.
Choice C reason: Hyperactive bowel sounds are a common manifestation of hypermetabolism due to hyperthyroidism. The increased metabolic rate accelerates gastrointestinal motility, resulting in hyperactive bowel sounds and sometimes diarrhea.
Choice D reason: 1+ pitting edema noted in bilateral lower extremities is related to fluid retention and heart failure rather than hypermetabolism. Edema is not a typical manifestation of hyperthyroidism and is more indicative of cardiovascular or renal issues.
Choice E reason: A heart rate of 124 (tachycardia) is a common finding in patients with hyperthyroidism. Excess thyroid hormones increase the heart rate and cardiac output, leading to symptoms such as palpitations and tachycardia.
Choice F reason: Bounding radial pulses are indicative of increased cardiac output and stroke volume, which are common in hyperthyroidism due to the hypermetabolic state induced by excess thyroid hormones. This leads to strong and forceful pulses.
Choice G reason: Anxious and restless behavior is a manifestation of the increased adrenergic activity associated with hyperthyroidism. Excess thyroid hormones stimulate the nervous system, leading to symptoms such as anxiety, restlessness, and irritability.
Choice H reason: Diminished breath sounds with fine crackles in the posterior bases are not directly related to hypermetabolism. These findings are more indicative of fluid overload or heart failure, which can occur in patients with Graves' disease, especially if their heart failure is not well managed.

A. Increased serum chloride B. Elevated hematocrit C. Decreased serum sodium D. Low urine specific gravity

Correct Answer is C

Explanation

Choice A reason: Increased serum chloride is not a typical finding associated with syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, the body's regulation of water is impaired, leading to water retention and dilutional hyponatremia. Serum chloride levels might not be significantly affected and are not the primary laboratory indicator for this condition.
Choice B reason: Elevated hematocrit is not directly related to SIADH. Hematocrit levels reflect the proportion of red blood cells in the blood. In SIADH, the main issue is water retention leading to dilutional hyponatremia, rather than changes in red blood cell concentration. Therefore, hematocrit levels are not a key laboratory finding in this disorder.
Choice C reason: Decreased serum sodium, or hyponatremia, is a hallmark finding in SIADH. The excessive release of antidiuretic hormone (ADH) leads to water retention, diluting the sodium in the blood and resulting in low serum sodium levels. This hyponatremia can cause symptoms such as disorientation, headache, and muscle cramps, as seen in the patient. Monitoring and correcting serum sodium levels is crucial in the management of SIADH.
Choice D reason: Low urine specific gravity is not expected in SIADH. In fact, patients with SIADH typically have a high urine specific gravity due to the excessive release of ADH, which causes the kidneys to reabsorb water and concentrate the urine. This concentrated urine reflects the body's attempt to reduce water excretion in response to elevated ADH levels. Therefore, low urine specific gravity would not be an initial laboratory finding in this condition.

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","C","E","F","G"]

Explanation

A patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result would the nurse expect?

Correct Answer is C

Explanation

Causative factors for the development of delirium include which of the following? Select all that apply.

Which group of drugs will the nurse plan to include when teaching a patient who has a new diagnosis of peripheral artery disease (PAD)? Select all that apply:

Order the steps for completing a blood transfusion.

The clinical diagnosis of dementia is based on

Marvin is transferred from the ICU to the Tele/Neuro unit 24 hours after receiving tPA. He has left sided hemiplegia with some dysphagia. What nursing interventions should be part of his plan of care? Select all that apply.

Elevated serum ammonia level causes which complication of cirrhosis?

How is Addison disease treated and clinically managed?

A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes. The pain goes away after I stop walking, though." Which focused assessment would the nurse make?