A client who is taking warfarin has an international normalized ratio (INR) of 0.8. Which question should a nurse ask to further evaluate the client?

Do your gums bleed when you brush your teeth?.

Are you taking the medication as prescribed?.

Have you noticed blood in your stools?.

Do you have any unusual bruising?.

Answer and Explanation

The Correct Answer is B

Are you taking the medication as prescribed? This is because warfarin is a blood-thinning medication that affects the prothrombin time (PT) and the international normalized ratio (INR).

The PT measures how long it takes for blood to clot, and the INR is a calculation based on the PT that standardizes the results across different laboratories. A normal INR range is 0.8 to 1.1 for people who are not taking warfarin. People who take warfarin usually have a target INR range of 2 to 3, depending on their condition.

An INR of 0.8 means that the blood clots faster than normal, which increases the risk of blood clots and strokes.

This could indicate that the client is not taking enough warfarin or is taking other medications or foods that interfere with warfarin’s effect.

Choice A is wrong because bleeding gums are a sign of excessive bleeding, which could happen if the INR is too high, not too low.

Choice C is wrong because blood in stools is also a sign of excessive bleeding, which could happen if the INR is too high, not too low.

Choice D is wrong because unusual bruising is another sign of excessive bleeding, which could happen if the INR is too high, not too low.

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Correct Answer is A

Explanation

This is because aspirin can cause gastrointestinal bleeding, ulceration, and perforation as side effects. Tarry-colored stools indicate the presence of blood in the stool, which is a sign of bleeding in the upper gastrointestinal tract.

This is a serious condition that requires immediate medical attention.

Choice B. Swelling of the leg and knee is wrong because it is not related to aspirin use.

It may indicate inflammation, infection, or injury of the leg and knee, but it is not a priority symptom to report to the HCP.

Choice C. Right upper quadrant discomfort is wrong because it is not related to aspirin use.

It may indicate liver or gallbladder problems, but it is not a priority symptom to report to the HCP.

Choice D. Bruising around the injured knee is wrong because it is not related to aspirin use.

It may indicate trauma, bleeding disorders, or coagulation problems, but it is not a priority symptom to report to the HCP.

Normal ranges for bleeding time are 2 to 7 minutes. Normal ranges for PTT are 25 to 35 seconds. Normal ranges for liver enzymes are AST 10 to 40 U/L and ALT 7 to 56 U/L.

A. An idiosyncratic drug effect. B. A toxic drug effect. C. An allergic drug response. D. An unexpected drug interaction.

Correct Answer is A

Explanation

An idiosyncratic drug effect is an unpredictable and uncommon reaction to a drug that is not related to the dose, the pharmacology, or the patient’s allergy or intolerance. It may be caused by genetic factors, metabolic abnormalities, or interactions with other drugs or substances. An example of an idiosyncratic drug effect is paradoxical agitation or excitement after receiving a sedative.

B. A toxic drug effect is a harmful reaction to a drug that is related to the dose or the pharmacology of the drug. It may cause symptoms such as nausea, vomiting, drowsiness, confusion, or respiratory depression. A toxic drug effect is unlikely to cause agitation after receiving a sedative unless there is an overdose or a drug interaction that increases the level of the sedative in the blood.

C. An allergic drug response is an immunological reaction to a drug that is not related to the dose or the pharmacology of the drug. It may cause symptoms such as rash, itching, swelling, fever, or anaphylaxis. An allergic drug response is unlikely to cause agitation after receiving a sedative unless there is a severe anaphylactic reaction that affects the brain or the circulation.

D. An unexpected drug interaction is a modification of the effect of one drug by another drug or substance that is not predictable based on their pharmacology. It may cause an increase or a decrease in the efficacy or toxicity of one or both drugs. An unexpected drug interaction may cause agitation after receiving a sedative if there is a synergistic effect that enhances the central nervous system stimulation of another drug or substance (such as caffeine, cocaine, or amphetamines) or if there is an antagonistic effect that reduces the central nervous system depression of the sedative (such as flumazenil, naloxone, or physostigmine). However, these interactions are usually known and avoidable by checking the patient’s history and medication list.

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A client who is taking warfarin has an international normalized ratio (INR) of 0.8. Which question should a nurse ask to further evaluate the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has been taking aspirin 325 mg six to eight times a day for the past two weeks to control pain from a knee injury. Which symptom reported by the client should the nurse report to the health care provider (HCP) for priority follow-up?

Correct Answer is A

Explanation

Which statement best documents the situation when a client becomes extremely agitated after receiving a sedative?

Correct Answer is A

Explanation

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