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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E","F"]
Explanation
Choice A reason: Monitoring for signs of dehydration is crucial because Mr. Carter's symptoms of nausea and vomiting can lead to fluid loss. Ensuring adequate hydration is essential for maintaining overall health and supporting liver function.
Choice B reason: Providing education about proper hand hygiene is important to prevent the transmission of hepatitis A, especially since Mr. Carter recently traveled to an area where he may have been exposed to the virus. Proper hand hygiene can help reduce the risk of spreading the infection to others.
Choice C reason: Encouraging a high-protein dietary intake is not appropriate in this case. While protein is important for liver repair, Mr. Carter's liver function is compromised, and a high-protein diet may increase the liver's workload. Instead, a balanced diet with adequate calories and nutrients is recommended.
Choice D reason: Administering intravenous antibiotics is not indicated for hepatitis A, as it is a viral infection and not bacterial. Antibiotics would not be effective in treating this condition.
Choice E reason: Advising rest and limiting physical activity is important to support recovery. Mr. Carter's symptoms of fatigue and jaundice indicate that his body needs time to heal. Resting helps conserve energy and allows the liver to recover.
Choice F reason: Educating the patient about the need for lifelong hepatitis A vaccination is crucial. Although hepatitis A does not typically cause chronic infection, vaccination can prevent future infections and protect against the virus.
Correct Answer is ["C","E","F"]
Explanation
Choice A reason: Applying a clean, dry dressing over the VTE/DVT site is not necessary. VTE/DVT usually involves deep veins where there are no visible wounds requiring dressings. This instruction is irrelevant to the management and discharge instructions for a patient with DVT on anticoagulant therapy.
Choice B reason: Monitoring activated partial thromboplastin time (aPTT) results is relevant for heparin therapy, not for warfarin. Warfarin therapy is monitored using the international normalized ratio (INR). Therefore, this instruction is not appropriate for a patient being discharged on warfarin.
Choice C reason: Administering the warfarin dose at the same time each day is crucial for maintaining consistent blood levels of the medication, ensuring its effectiveness. It helps to maintain steady anticoagulation and reduces the risk of complications associated with fluctuating blood levels of warfarin.
Choice D reason: Instructing the patient to take aspirin or NSAIDs as needed for pain is inappropriate because these medications can increase the risk of bleeding when taken with warfarin. Patients on warfarin should avoid these medications and use alternatives like acetaminophen (Tylenol) for pain relief.
Choice E reason: Advising the patient to use electric razors, not straight razors, when shaving is important to prevent cuts and bleeding. Warfarin increases the risk of bleeding, and using an electric razor minimizes the chance of nicks and cuts that could lead to significant bleeding.
Choice F reason: Monitoring the level of anticoagulation with warfarin using INR results is essential. Regular INR monitoring ensures that the patient maintains a therapeutic level of anticoagulation and helps prevent both clotting and bleeding complications. Adjustments to the warfarin dose are made based on INR results.
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