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 B

Explanation

Choice A reason: Quad coughing is a technique used to help patients with spinal cord injuries improve their coughing ability, but it does not directly prevent autonomic dysreflexia. While it is beneficial for respiratory health, it is not the primary intervention for preventing autonomic dysreflexia.
Choice B reason: Assisting to plan a prescribed bowel program is crucial in preventing autonomic dysreflexia. Bowel impaction is a common trigger for autonomic dysreflexia, and a regular bowel program helps to prevent constipation and ensure regular bowel movements, reducing the risk of this complication.
Choice C reason: Supporting the selection of a high-protein diet is important for overall health and nutrition, but it does not directly prevent autonomic dysreflexia. While proper nutrition is essential for patients with spinal cord injuries, it is not the primary intervention for preventing autonomic dysreflexia.

A. Suggest the use of adult incontinence briefs for nighttime only. B. Assist the patient to the commode every 2 hours during the day. C. Teach the patient how to self-catheterize. D. Encourage decreased evening intake of fluid.

Correct Answer is C

Explanation

Choice A reason: Suggesting the use of adult incontinence briefs for nighttime only may help manage incontinence during the night, but it does not address the primary issue of urinary retention caused by a flaccid bladder. Incontinence briefs are a passive approach and do not prevent urinary retention or the complications associated with it, such as urinary tract infections and kidney damage. Additionally, it does not empower the patient to actively manage their urinary retention.
Choice B reason: Assisting the patient to the commode every 2 hours during the day can help to some extent in managing urinary retention. However, this approach requires constant assistance and is not practical for long-term management, especially when the patient is alone or in settings where frequent assistance is not available. This method also does not ensure complete bladder emptying, which is crucial for preventing urinary tract infections and other complications.
Choice C reason: Teaching the patient how to self-catheterize is the most appropriate and effective action for managing urinary retention caused by a flaccid bladder. Self-catheterization allows the patient to empty the bladder regularly and completely, reducing the risk of urinary tract infections, bladder distention, and kidney damage. It also provides the patient with a sense of control and independence in managing their condition. Self-catheterization is a standard and recommended practice for individuals with neurogenic bladder dysfunction due to multiple sclerosis.
Choice D reason: Encouraging decreased evening intake of fluid can help reduce nighttime urination, but it does not address the issue of urinary retention caused by a flaccid bladder. Decreasing fluid intake is not a comprehensive solution and does not prevent complications associated with incomplete bladder emptying. It is important to manage fluid intake appropriately, but this should be part of a broader strategy that includes effective bladder emptying techniques like self-catheterization.

View Question and Answer

Test	Result	Normal Range
ALT (Alanine Aminotransferase)	1.200 U/L	7-56 U/L
AST (Aspartate Aminotransferase)	1.000 U/L	10-40 U/L
Total Bilirubin	5.5 mg/dL	0.1-1.2 mg/dL
Hepatitis A IgM	Positive	Negative

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Naxlex Comprehensive Predictor Exams

To prevent autonomic dysreflexia, which nursing action would the home health nurse include in the plan of care for a patient who has paraplegia at the T4 level?

Correct Answer is B

Explanation

Which action should the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder?

Correct Answer is C

Explanation

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

Which finding indicates to the nurse that the current therapies are effective for a patient who has Addison's disease?

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?

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

The clinical diagnosis of dementia is based on

Important nursing interventions when caring for a patient with Cushing syndrome include: