A nurse is caring for a patient who is newly diagnosed with deep vein thrombosis and has been on a continuous heparin infusion for 3 days. The provider prescribes oral warfarin without discontinuing the heparin. The patient asks why both drugs are necessary. What is the appropriate response by the nurse?
A "Warfarin takes several days to work, so the heparin will be used until the warfarin reaches a therapeutic level."
"The heparin increases the effects of the warfarin and decreases the length of your hospital stay."
"I will call the provider to discontinue the heparin."
"Both medications work together to dissolve the clots."
The Correct Answer is A
A. "Warfarin takes several days to work, so the heparin will be used until the warfarin reaches a therapeutic level":
This response is correct because warfarin, an oral anticoagulant, takes several days to reach its full therapeutic effect due to its mechanism of action on vitamin K-dependent clotting factors. Therefore, heparin, which has an immediate onset of action, is used concurrently to prevent new clot formation until warfarin reaches therapeutic levels. Once warfarin reaches its therapeutic range, heparin is typically discontinued.
B. "The heparin increases the effects of the warfarin and decreases the length of your hospital stay":
This statement is incorrect. While heparin and warfarin both act as anticoagulants, they have different mechanisms of action. Heparin works rapidly by inhibiting thrombin, while warfarin acts more slowly by inhibiting vitamin K-dependent clotting factors. The concurrent use of heparin and warfarin is not to increase the effects of warfarin but rather to bridge the gap until warfarin reaches therapeutic levels.
C. "I will call the provider to discontinue the heparin":
Discontinuing heparin without a clear order from the provider could be inappropriate and potentially dangerous. Abrupt discontinuation of heparin before warfarin reaches therapeutic levels could increase the risk of thrombus formation or embolization. The decision to discontinue heparin should be made by the provider based on the patient's individual clinical status and response to therapy.
D. "Both medications work together to dissolve the clots":
While both heparin and warfarin are anticoagulants used to prevent further clot formation and propagation, they do not directly dissolve existing clots. Instead, they prevent the formation of new clots and allow the body's natural fibrinolytic system to gradually break down existing clots. Therefore, this statement is not entirely accurate in describing the mechanism of action of these medications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Administer post-exposure prophylaxis medication: While post-exposure prophylaxis (PEP) medication may be necessary in certain cases of needlestick injuries involving potential exposure to HIV, it is not the first step to perform. The initial priority is to ensure the safety of the healthcare provider and prevent potential transmission of the virus.
B. Determine the HIV status of the patient: Determining the HIV status of the patient is essential for risk assessment and guiding subsequent management. However, this step may take some time, and immediate action to protect the healthcare provider should not be delayed while waiting for the patient's HIV status to be confirmed.
C. Advise exposed healthcare providers to use precautions: This is the first step to perform after a needlestick injury. Healthcare providers should be immediately advised to use standard precautions, including hand hygiene and the use of personal protective equipment, to minimize the risk of transmission of bloodborne pathogens.
D. Undergo early reevaluation after exposure: Early reevaluation after exposure is important to assess the risk of transmission and determine the need for further interventions, including PEP medication. However, advising exposed healthcare providers to use precautions should take precedence as an immediate response to the injury.
Correct Answer is C
Explanation
A. Sedentary lifestyle: While a sedentary lifestyle can contribute to the development and progression of peripheral arterial disease (PAD), it is not the highest risk factor compared to other options listed. Regular physical activity is important for cardiovascular health and can help reduce the risk of PAD, but other risk factors may have a greater impact on disease development.
B. Diabetes: Diabetes is a significant risk factor for PAD, especially when poorly controlled. High blood sugar levels can damage blood vessels and nerves, leading to atherosclerosis and reduced blood flow to the limbs. However, compared to cigarette smoking, diabetes may not be considered the highest risk factor for PAD.
C. Cigarette smoking: Cigarette smoking is the highest risk factor for peripheral arterial disease (PAD). Tobacco smoke contains numerous harmful chemicals that damage blood vessels and promote atherosclerosis, narrowing the arteries and reducing blood flow to the limbs. Smoking not only increases the risk of developing PAD but also accelerates its progression and worsens symptoms. Quitting smoking is one of the most important interventions for preventing and managing PAD.
D. Hyperlipidemia: Elevated levels of cholesterol and triglycerides (hyperlipidemia) contribute to the development of atherosclerosis, which is a key mechanism underlying peripheral arterial disease (PAD). However, while hyperlipidemia is a significant risk factor, it may not be considered the highest risk factor compared to cigarette smoking. Controlling cholesterol levels through lifestyle changes and medications is essential for managing PAD and reducing cardiovascular risk.
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