A nurse is preparing a client for discharge home after an admission for bilateral pulmonary emboli. The client is prescribed warfarin in addition to regular daily medications. Which of the following actions should the nurse take?

Consult the pharmacist about potential interactions between the client's regular medications and warfarin.

Tell the client they can continue to drink cranberry juice while taking warfarin.

Recommend the client take warfarin at the same time as other medications.

Advise the client that over-the-counter medications remain safe to consume as needed.

Answer and Explanation

The Correct Answer is A

Rationale:

A. Consult the pharmacist about potential interactions between the client's regular medications and warfarin: Warfarin has numerous drug interactions that can increase bleeding risk or reduce effectiveness. Consulting the pharmacist ensures a thorough review of the client’s medication list for potential harmful interactions before discharge.

B. Tell the client they can continue to drink cranberry juice while taking warfarin: Cranberry juice can potentiate the effects of warfarin and increase bleeding risk by interfering with its metabolism. Clients should be advised to limit or avoid cranberry products.

C. Recommend the client take warfarin at the same time as other medications: Warfarin should be taken at the same time each day, but taking it with other medications may cause interactions. The timing should consider spacing it from medications that might interfere with absorption or potency.

D. Advise the client that over-the-counter medications remain safe to consume as needed: Many OTC medications, especially NSAIDs, can increase bleeding risk when combined with warfarin. Clients need to check with a healthcare provider before taking any new OTC drugs.

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Correct Answer is A

Explanation

Rationale:

A. "Your family disagrees with your decision?": This open-ended response reflects therapeutic communication by encouraging the client to express her feelings without judgment. It invites further discussion and shows the nurse’s support for the client’s autonomy and emotional well-being.

B. "Did you tell your provider that your family doesn't agree with your decision?": This response shifts focus away from the client's emotional conflict and places it on the provider. It may dismiss the client’s current need for support and hinder further emotional exploration.

C. "You are making the same decision I would make.": Personalizing the conversation undermines client autonomy. The nurse’s role is to support the client’s decision-making process, not impose personal opinions or make assumptions about what is best.

D. "You should get your family to agree with your decision before signing the consent.": This response suggests the client must yield to family opinions, which contradicts the principle of informed consent. The decision is ultimately the client’s, and family agreement is not a legal or ethical requirement.

A. "Apply the ointment to the skin every 4 hr." B. "Spread the ointment in a thin, even layer.” C. "Apply the ointment to the forearm." D. "Massage the ointment into the skin."

Correct Answer is B

Explanation

Rationale:

A. "Apply the ointment to the skin every 4 hr.": Nitroglycerin topical ointment is applied every 6 to 8 hours, depending on the provider's instructions. Applying it every 4 hours may increase the risk of side effects such as hypotension or tolerance due to excessive dosing frequency.

B. "Spread the ointment in a thin, even layer.": The medication should be applied in a thin, consistent layer to allow for proper absorption through the skin. The dose is usually measured and spread using applicator paper, avoiding rubbing or massaging it in.

C. "Apply the ointment to the forearm.": The preferred application sites are hairless areas of the chest, back, or upper arms. The forearm is not typically used due to variability in absorption and the presence of thinner skin and more movement.

D. "Massage the ointment into the skin.": Nitroglycerin ointment should never be massaged into the skin. Massaging can lead to unpredictable absorption rates and an increased risk of hypotension or headache due to rapid systemic absorption.

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A nurse is preparing a client for discharge home after an admission for bilateral pulmonary emboli. The client is prescribed warfarin in addition to regular daily medications. Which of the following actions should the nurse take?

Nursing Test Bank

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