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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Correct Answer is C

Explanation

A) "Take the medication with meals":
Rifampin should ideally be taken on an empty stomach, as food can interfere with its absorption. Taking it with meals may decrease its effectiveness. Instructing the client to take rifampin at least 1 hour before or 2 hours after meals ensures optimal absorption and effectiveness of the medication.

B) "Purified protein derivative skin test results will improve in 3 months":
Rifampin does not affect the results of the purified protein derivative (PPD) skin test for tuberculosis. The PPD test measures the immune response to tuberculosis infection and is not influenced by rifampin therapy. It's important to clarify that the PPD test is used for diagnosis and monitoring of tuberculosis infection, not as a marker for medication effectiveness.

C) "Urine and other secretions will turn orange":
This is a common and harmless side effect of rifampin. It can cause discoloration of urine, sweat, tears, and other secretions to an orange-red color. Informing the client about this side effect prevents unnecessary concern and ensures they are aware of what to expect while taking rifampin.

D) "Expect to have insomnia while taking this medication":
Insomnia is not a common side effect of rifampin. Rifampin can cause other side effects such as gastrointestinal upset, hepatotoxicity, and flu-like syndrome, but insomnia is not typically reported. It's important to educate the client about potential side effects that are more commonly associated with rifampin therapy.

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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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing discharge teaching with a client who has pulmonary tuberculosis and is to start taking rifampin. Which of the following information should the nurse include?

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 reinforcing teaching for a client who has angina pectoris and a new prescription to apply a nitroglycerin transdermal patch daily at home. Which of the following instructions should the nurse give the client?

A nurse is assisting in the education of a group of clients about the contraindications of warfarin therapy. Which of the following statements is appropriate to include in the instructions?

The nurse is preparing to administer ear drops to an adult client. Which of the following actions should the nurse plan to take?

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 is reinforcing teaching with a client who is to start taking enteric-coated naproxen for rheumatoid arthritis. Which of the following client statements by the client indicates a need for further teaching?

A nurse is reviewing the medication history of a client. The nurse should identify that which of the following medications places the client at risk for hypokalemia?

A nurse is reinforcing teaching for a client who has angina pectoris and a new prescription to apply a nitroglycerin transdermal patch daily at home. Which of the following instructions should the nurse give the client?