A client is discharged with a prescription for warfarin. Which discharge instruction should the nurse emphasize to the client?

Take a multi-vitamin supplement daily.

Use an astringent for superficial bleeding.

Add large amounts of spinach to the diet.

Avoid going barefoot, especially outside.

Answer and Explanation

The Correct Answer is D

Choice A reason: Taking a multi-vitamin supplement daily is not a necessary instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. However, some vitamins, such as vitamin K, vitamin E, and vitamin C, can interact with warfarin and affect its effectiveness. Patients should consult their health care provider before taking any supplements or herbal products.

Choice B reason: Using an astringent for superficial bleeding is not a sufficient instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Warfarin can increase the risk of bleeding, both internally and externally. Patients should report any signs of bleeding, such as bruising, nosebleeds, gum bleeding, blood in urine or stool, or prolonged bleeding from cuts or wounds, to their health care provider. They should also avoid activities or products that can increase the risk of bleeding, such as shaving with a razor, using dental floss, or taking aspirin or NSAIDs.

Choice C reason: Adding large amounts of spinach to the diet is an incorrect instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Spinach is a leafy green vegetable that is high in vitamin K, which can counteract the effect of warfarin and increase the risk of clotting. Patients should maintain a consistent intake of vitamin K-rich foods and avoid sudden changes in their diet.

Choice D reason: Avoiding going barefoot, especially outside, is a correct instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Warfarin can increase the risk of bleeding, both internally and externally. Patients should protect their feet from injury or infection by wearing shoes or slippers at all times.

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

Explanation

Choice A reason:

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that has analgesic, anti-inflammatory, and antipyretic effects. Ibuprofen can be prescribed along with morphine to enhance the pain relief and reduce the inflammation caused by the surgery. Ibuprofen can also reduce the opioid requirement and the risk of opioid-related side effects, such as nausea, constipation, and respiratory depression. Therefore, choice A is correct.

Choice B reason:

Propofol is a short-acting intravenous anesthetic agent that induces and maintains anesthesia and sedation. Propofol is not prescribed along with morphine for post-operative pain management, as it is not an analgesic and has a high risk of hypotension, bradycardia, and respiratory depression. Propofol is only used in controlled settings, such as the operating room or the intensive care unit, under close monitoring and supervision. Therefore, choice B is incorrect.

Choice C reason:

Methadone is a long-acting synthetic opioid that has analgesic and opioid substitution effects. Methadone is not prescribed along with morphine for post-operative pain management, as it is not indicated for acute pain and has a high risk of accumulation, overdose, and addiction. Methadone is mainly used for chronic pain or opioid dependence treatment, under strict regulation and monitoring. Therefore, choice C is incorrect.

Choice D reason:

Senna is a stimulant laxative that increases the intestinal motility and promotes bowel movements. Senna can be prescribed along with morphine to prevent or treat constipation, which is a common side effect of opioids. Senna can improve the comfort and quality of life of the client who is receiving opioid therapy. Therefore, choice D is correct.

Choice E reason:

Docusate sodium is a stool softener that increases the water content and softness of the stool. Docusate sodium can be prescribed along with morphine to prevent or treat constipation, which is a common side effect of opioids. Docusate sodium can improve the comfort and quality of life of the client who is receiving opioid therapy. Therefore, choice E is correct.

Choice F reason:

Naloxone is an opioid antagonist that reverses the effects of opioids by displacing them from their receptors. Naloxone is not prescribed along with morphine for post-operative pain management, as it would counteract the analgesic effect of morphine and cause withdrawal symptoms. Naloxone is only used in emergency situations, such as opioid overdose or respiratory depression, as a rescue medication. Therefore, choice F is incorrect.

A. Midmorning. B. No peak occurs. C. Midafternoon. D. Shortly after midnight.

Correct Answer is B

Explanation

Choice A reason: Midmorning is not a likely time for experiencing hypoglycemia after administering glargine insulin at 0800, because glargine insulin has a slow onset of action (about 1 hour) and does not have a pronounced peak effect. Glargine insulin is a long-acting insulin that provides a steady level of insulin throughout the day and night.

Choice B reason: No peak occurs is the correct answer for when hypoglycemia is most likely to occur after administering glargine insulin at 0800, because glargine insulin does not have a pronounced peak effect that could cause a sudden drop in blood glucose levels. Glargine insulin is a long-acting insulin that provides a steady level of insulin throughout the day and night.

Choice C reason: Midafternoon is not a likely time for experiencing hypoglycemia after administering glargine insulin at 0800, because glargine insulin has a long duration of action (about 24 hours) and does not have a pronounced peak effect. Glargine insulin is a long-acting insulin that provides a steady level of insulin throughout the day and night.

Choice D reason: Shortly after midnight is not a likely time for experiencing hypoglycemia after administering glargine insulin at 0800, because glargine insulin has a long duration of action (about 24 hours) and does not have a pronounced peak effect. Glargine insulin is a long-acting insulin that provides a steady level of insulin throughout the day and night.

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A client is discharged with a prescription for warfarin. Which discharge instruction should the nurse emphasize to the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Patient Data Exhibits What other medications would the nurse expect the surgeon to prescribe along with morphine? Select all that apply.

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

Explanation

The nurse is teaching a client with type 1 diabetes mellitus (DM) about the onset, peak, and duration of a new prescription for glargine insulin. If the insulin is administered at 0800, when is the client most likely to experience hypoglycemia?

Correct Answer is B

Explanation

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