A nurse is caring for a client who has a deep vein thrombosis, who received IV heparin for the past 5 days, and now has a new prescription for oral warfarin in addition to the heparin. The client asks the nurse if both medications are necessary. Which of the following is an appropriate response by the nurse?

"Heparin enhances the effects of the warfarin."

"Both heparin and warfarin work together to dissolve the clots."

"Heparin will be continued until the warfarin reaches a therapeutic level!"

"I will ask the charge nurse to call your provider and get an explanation"

Answer and Explanation

The Correct Answer is C

A) "Heparin enhances the effects of the warfarin.": This statement is incorrect. Heparin and warfarin work through different mechanisms. Heparin acts quickly by inhibiting clot formation through antithrombin, while warfarin acts slower by inhibiting vitamin K-dependent clotting factors. They do not directly enhance each other's effects.

B) "Both heparin and warfarin work together to dissolve the clots.": This is inaccurate. Neither heparin nor warfarin dissolve existing clots; they prevent new clots from forming and existing clots from growing. The body's natural processes will eventually dissolve the clot.

C) "Heparin will be continued until the warfarin reaches a therapeutic level!": This is correct. Heparin is used initially because it acts quickly. Warfarin takes several days to reach therapeutic levels. Overlapping the two ensures continuous anticoagulation until warfarin is effective.

D) "I will ask the charge nurse to call your provider and get an explanation.": While involving the provider for further explanation can be helpful, it does not directly answer the client’s question. Providing accurate information about the overlapping use of heparin and warfarin is more appropriate in this context.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

A) Vomiting:
Vomiting can occur postoperatively due to various reasons such as anesthesia, medications, or surgical stress. While vomiting should be monitored closely for dehydration and electrolyte imbalance, it is not typically an early sign of circulatory overload.

B) Flushing:
Flushing, or skin redness and warmth, can occur due to vasodilation from anesthesia or medications. It is not specific to circulatory overload unless accompanied by other signs such as dyspnea, elevated blood pressure, and fluid retention.

C) Dyspnea:
Dyspnea, or difficulty breathing, is a critical early sign of circulatory overload in clients receiving IV fluids and blood products. It indicates fluid accumulation in the lungs, necessitating immediate nursing intervention to prevent respiratory distress.

D) Bradycardia:
Bradycardia, or a slow heart rate, can occur postoperatively due to anesthesia effects or vagal stimulation. However, it is not typically associated with circulatory overload, which more commonly manifests with tachycardia as the heart attempts to compensate for increased fluid volume.

A. A client taking a potassium supplement twice a day B. A client taking aluminum hydroxide for gastric upset C. A client taking chlorpropamide for type 2 diabetes mellitus D. A client taking furosemide for chronic hypertension

Correct Answer is D

Explanation

A) A client taking a potassium supplement twice a day:
Taking potassium supplements can actually lower the risk of digoxin toxicity because hypokalemia (low potassium levels) increases the risk of digoxin toxicity. Potassium supplements help maintain adequate potassium levels, which is beneficial for clients taking digoxin.

B) A client taking aluminum hydroxide for gastric upset:
Aluminum hydroxide can bind to digoxin in the gastrointestinal tract, reducing its absorption. This interaction can decrease the effectiveness of digoxin rather than increase the risk of toxicity.

C) A client taking chlorpropamide for type 2 diabetes mellitus:
Chlorpropamide does not interact significantly with digoxin or affect electrolyte levels in a way that would increase the risk of digoxin toxicity.

D) A client taking furosemide for chronic hypertension:
Furosemide, a loop diuretic, can cause hypokalemia and hypomagnesemia, which are risk factors for digoxin toxicity. Low potassium levels enhance the toxicity of digoxin by increasing its binding to cardiac tissue receptors, leading to enhanced cardiac effects.

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Naxlex Comprehensive Predictor Exams

A client who is postoperative is receiving IV fluids and a unit of whole blood. The nurse should observe the client for which of the following as an early sign of circulatory overload?

Correct Answer is C

Explanation

A nurse is reviewing the morning laboratory results of electrolytes for four clients who are receiving digoxin. Which of the following clients should the nurse identify as being at risk for developing digoxin toxicity?

Correct Answer is D

Explanation

A nurse is caring for a client who has cirrhosis and a prescription for lactulose. Following administration, the nurse should monitor the client for which of the following adverse effects?

A nurse is reinforcing teaching with a client who has multiple sclerosis and a new prescription for baclofen. Which of the following instructions should the nurse include?

A nurse administered nitroglycerin sublingually to a client who has angina pectoris and experienced chest pain. The client states that his chest pain is relieved but now he has a headache. Which of the following responses by the nurse is appropriate?

A nurse is preparing to administer 0.9% sodium chloride (NaCl) 750 mL IV to infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr.? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is reinforcing teaching with a client who has osteoporosis and is prescribed alendronate 70 mg PO weekly. Which of the following statements by the client indicates a need for further instruction?

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous infusion of heparin. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse make?

A nurse is reinforcing teaching with a client with bacterial conjunctivitis of the right eye, and a prescription for an antibiotic ophthalmic ointment. Which of the following statements should the nurse make?