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 D

Explanation

Choice A reason:
Administering furosemide in this scenario would further lower the serum potassium level, as furosemide is a loop diuretic known for causing potassium loss through urine. This action could worsen the patient’s hypokalemia, leading to severe complications such as cardiac arrhythmias. Therefore, administering furosemide in the presence of hypokalemia is inappropriate and could put the patient at significant risk.
Choice B reason:
Administering both spironolactone and furosemide together without addressing the hypokalemia would not be safe. While spironolactone is a potassium-sparing diuretic, combining it with furosemide could negate its potassium-sparing effects. Furthermore, administering furosemide when hypokalemia is present could cause further electrolyte imbalance. Proper evaluation of the patient's condition and selective administration of the medications are crucial in this case.
Choice C reason:
Withholding both medications and attributing the decision to contraindications with hyperkalemia is incorrect because the reported potassium level (3.2 mEq/L) reflects hypokalemia, not hyperkalemia. Misinterpreting the lab result could delay appropriate treatment, such as correcting the potassium level or safely administering a medication that would not exacerbate the hypokalemia. Proper communication with the healthcare provider is necessary for effective patient care.
Choice D reason:
Administering spironolactone is the best action in this scenario because it is a potassium-sparing diuretic. By administering spironolactone, the risk of worsening hypokalemia is minimized. Notifying the healthcare provider about the low potassium level ensures appropriate monitoring and any necessary interventions, such as potassium supplementation. This approach is both safe and effective in managing the patient’s current condition while adhering to standard nursing practices.

A. Sedatives and opioids B. Alcohol use C. Untreated pain D. Sleep deprivation E. Sensory overload

Correct Answer is ["A","B","C","D","E"]

Explanation

Choice A reason: Sedatives and opioids are known to cause delirium, especially in older adults or those with compromised health. These medications can affect the central nervous system, leading to confusion and cognitive impairment.
Choice B reason: Alcohol use, particularly in combination with withdrawal, can lead to delirium. Alcohol affects neurotransmitter function and can cause significant changes in mental status when consumed in excess or withdrawn abruptly.
Choice C reason: Untreated pain can contribute to delirium, particularly in patients who are already vulnerable due to age or underlying health conditions. Pain can cause significant stress on the body and mind, leading to confusion and cognitive dysfunction.
Choice D reason: Sleep deprivation is a significant factor in the development of delirium. Lack of sleep can impair cognitive function and increase the risk of delirium, especially in hospitalized patients or those with pre-existing cognitive impairments.
Choice E reason: Sensory overload, such as exposure to loud noises, bright lights, or unfamiliar environments, can contribute to delirium. Patients with sensory impairments or those in unfamiliar settings are particularly at risk.

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Naxlex Comprehensive Predictor Exams

A serum potassium level of 3.2 mEq/L is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Choose the best nursing action.

Correct Answer is D

Explanation

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

Correct Answer is ["A","B","C","D","E"]

Explanation

Which patient statement indicates to the nurse that further instruction is needed about chronic syndrome of inappropriate antidiuretic hormone (SIADH)?

A 23-year-old college student is diagnosed with hepatitis A after returning from an international trip. During health education, the nurse explains how hepatitis A is transmitted. Which statement by the patient indicates a correct understanding of how the virus is spread?

The clinical diagnosis of dementia is based on

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?

Based on the patient's current condition, the nurse recognizes that the patient's priority needs will be to prevent:

An adult male is experiencing increased fatigue and occasional palpitations at rest. Which laboratory data would the nurse identify as consistent with these symptoms?

Interpret these clinical findings and determine the nurse's next action. Clinical Findings: Complaints of dizziness and unsteady gait. BP: 98/60 mmHg. Carbidopa-Levodopa last taken 30 minutes ago.