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."

Answer and Explanation

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.

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Correct Answer is C

Explanation

A. A 29-year-old female who reports drinking a glass of wine with dinner: While excessive alcohol consumption can contribute to hypertension, moderate alcohol intake, such as drinking a glass of wine with dinner, is not typically a significant risk factor for hypertension in the absence of other contributing factors. Therefore, this individual may not be considered at high risk for hypertension solely based on this information.

B. A 35-year-old male who works 50 hours a week: While chronic stress from long work hours can potentially contribute to hypertension, working 50 hours a week alone may not be sufficient to significantly increase the risk of hypertension, especially in the absence of other significant risk factors. Therefore, this individual may not be considered at high risk for hypertension solely based on this information.

C. A 50-year-old male who reports smoking 2 packs of cigarettes a day: Smoking is a significant risk factor for hypertension. Nicotine in cigarettes can cause blood vessels to narrow, leading to increased blood pressure. Smoking also damages blood vessel walls, making them more susceptible to plaque buildup and narrowing, further increasing the risk of hypertension. Therefore, this individual is at high risk for hypertension due to their smoking habit.

D. A 30-year-old female with a family history of diabetes mellitus: While a family history of diabetes mellitus may increase the risk of developing hypertension due to shared risk factors such as obesity and unhealthy lifestyle habits, it is not as directly associated with hypertension as smoking. Additionally, the individual's age and family history alone may not be sufficient to determine a significant risk for hypertension without additional information about lifestyle and other risk factors.

A. Dry skin B. Burning sensation C. Diarrhea D. Irregular heart rate

Correct Answer is D

Explanation

A. Dry skin:
Dry skin is not a commonly reported side effect of diltiazem, a calcium channel blocker used for blood pressure management. While dry skin can occur due to various reasons, it is less likely to be directly associated with diltiazem use. Therefore, it is not the side effect that the nurse should prioritize instructing the patient to report to the provider.

B. Burning sensation:
Although burning sensation is not a common side effect of diltiazem, it can occasionally occur as a skin reaction or hypersensitivity reaction to the medication. While this symptom may warrant attention, it is generally less concerning compared to other potential side effects of diltiazem. Therefore, while it is important for the patient to report any unusual sensations or discomfort, burning sensation alone may not be the most critical side effect to report.

C. Diarrhea:
Diarrhea is a potential side effect of diltiazem use. Calcium channel blockers like diltiazem can affect gastrointestinal motility and lead to gastrointestinal disturbances, including diarrhea. While diarrhea can be bothersome and may indicate intolerance to the medication, it is generally considered a common side effect rather than a severe adverse reaction. Therefore, while the nurse should educate the patient about the possibility of diarrhea and encourage reporting any persistent or severe cases, it may not be the most critical side effect to report to the provider.

D. Irregular heart rate:
Irregular heart rate, including bradycardia or tachycardia, is a significant and potentially serious side effect of diltiazem. As a calcium channel blocker, diltiazem can affect cardiac conduction, leading to alterations in heart rate and rhythm. Irregular heart rate can indicate a significant cardiovascular complication and may require prompt medical attention. Therefore, the nurse should prioritize instructing the patient to report any changes in heart rate, including palpitations, rapid heartbeat, or irregular pulse, to the provider immediately.

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Naxlex Comprehensive Predictor Exams

A nurse is screening a group of people at a community health event for hypertension. Which patient will the nurse identify is at risk for hypertension?

Correct Answer is C

Explanation

The nurse is caring for a patient taking diltiazem for blood pressure management. The nurse instructs the patient to report which side effect to the provider?

Correct Answer is D

Explanation

The nurse admits a patient with a history of human immunodeficiency virus (HIV). Patient reports severe diarrhea, vomiting for the past 6 days. Which action will the nurse perform first?

The nurse is assessing a patient diagnosed with hypertension several years ago. What assessment finding may indicate that target organ damage is now occurring?

A nurse is preparing to administer total parental nutrition (TPN) 1000 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr.? (Round the answer to the nearest whole number. Use a leading zero fit applies. Do not use a trailing zero.)

A nurse is teaching a patent who is taking warfarin for deep venous thrombosis. Which statement by the patient indicates a need for further teaching?

A nurse is conducting a health education about viral hepatitis B (HBV)in a community setting. An individual plans to travel to a country where hepatitis B is common. What will the nurse teach is the only preventive measure for HBV?

The nurse is caring for a patient after a popliteal bypass graft surgery. Which assessments will the nurse perform during the first postoperative day?

A nurse is caring for a patient with peripheral arterial disease. Which factor will the nurse identify as the highest risk?

The nurse has given nutritional instructions to a patient with acquired immune deficiency syndrome (AIDS) who has recurrent diarrhea. Which statement by the patient requires further instructions?