A client is being discharged on warfarin therapy.
What discharge instructions is the nurse required to provide? (Select all that apply.)
Dietary restrictions.
Driving restrictions.
Follow-up laboratory monitoring.
Possible drug-drug interactions.
Reason to take medication.
Wearing a Medic Alert bracelet.
Correct Answer : A,C,D,E,F
Choice A rationale
Warfarin is a vitamin K antagonist that inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX, and X. Clients must be instructed to maintain a consistent intake of vitamin K-rich foods, such as leafy green vegetables, to avoid fluctuations in warfarin's anticoagulant effect and to maintain a stable INR.
Choice B rationale
Warfarin therapy itself does not impose driving restrictions. The primary concern is the bleeding risk associated with the medication, which would not typically affect a person's ability to drive. Driving is not a discharge instruction required specifically because of the medication itself.
Choice C rationale
Regular laboratory monitoring of the International Normalized Ratio (INR) is essential to ensure the warfarin dosage is therapeutic and safe. The INR normal range is 0.8-1.2. The therapeutic range for warfarin is typically 2.0-3.0 for most indications. Clients need to understand the importance of these appointments.
Choice D rationale
Warfarin is highly protein-bound and metabolized by the cytochrome P450 enzyme system, making it susceptible to numerous drug-drug interactions. Educating the client about potential interactions with other medications, including over-the-counter drugs, is crucial to prevent either bleeding or clotting episodes.
Choice E rationale
A client's adherence to a medication regimen is significantly enhanced when they understand the purpose of the treatment. Explaining that warfarin prevents dangerous blood clots in conditions like atrial fibrillation or deep vein thrombosis helps the client appreciate the importance of consistent daily dosing.
Choice F rationale
Wearing a Medic Alert bracelet is a critical safety measure for clients on warfarin. In an emergency, this bracelet immediately informs healthcare providers that the person is on an anticoagulant, allowing them to make informed decisions about care and to recognize signs of potential bleeding complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Steak and French fries are high in saturated and trans fats, which raise LDL cholesterol. The dietary management of elevated lipid panels focuses on reducing these fats to decrease cardiovascular risk. Iceberg lettuce offers minimal nutritional value.
Choice B rationale
Baked chicken breast is a lean protein source, and baking avoids adding unhealthy fats. Broccoli and tomatoes are rich in soluble fiber and antioxidants, which can help lower LDL cholesterol and improve overall cardiovascular health. This meal choice is consistent with a heart-healthy diet.
Choice C rationale
Fried catfish is cooked in oil, increasing its saturated fat content. Cornbread often contains high amounts of fat and sugar, contributing to poor lipid profiles. These food choices would not be considered beneficial for managing an elevated lipid panel.
Choice D rationale
Spaghetti with meat sauce often contains high-fat ground meat, contributing to saturated fat intake. Garlic bread is typically prepared with butter or margarine, adding more unhealthy fats. This meal is high in carbohydrates and fats and is not a good choice for managing lipids. .
Correct Answer is D
Explanation
While nutritional status is crucial for wound healing, and labs such as albumin (normal range 3.5-5.0 g/dL) and prealbumin (normal range 15-36 mg/dL) are important indicators, assessing the underlying cause of non-healing is a priority. Drawing labs is a subsequent step after a thorough assessment has been completed to rule out circulatory issues as the primary cause.
Choice B rationale
A wound culture is performed to identify pathogens that may be causing a non-healing wound. However, it should only be done after assessing for other potential causes, such as poor circulation, which can compromise the delivery of immune cells and antibiotics to the wound site, making it impossible for the wound to heal regardless of the presence of bacteria.
Choice C rationale
Elevating the foot may be beneficial for reducing edema if present, which can impede circulation. However, this intervention should be based on a comprehensive circulatory assessment. Without first assessing the vascular status of the leg, this action is premature and may not be the most critical first step to take in addressing the underlying problem.
Choice D rationale
Assessing the right leg for pulses, skin color, and temperature is the most critical first step. A non-healing wound on an extremity, particularly an ankle, may indicate underlying peripheral arterial disease. Inadequate blood flow compromises oxygen and nutrient delivery to the wound bed, preventing cellular repair and growth. Ruling out or identifying circulatory compromise is the initial priority.
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