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A nurse is providing education for client newly prescribed warfarin in preparation for being discharged home. Which of the following should be included the teaching plan? (Select all that apply.)

You may start taking warfarin while still on Heparin when you are getting ready be discharged home

You will need to have your aPTT monitored frequently while on Warfarin

Use a soft-bristled toothbrush and avoid brushing too aggressively

You should replace straight razors with an electric shaver to avoid cuts

Increase foods high in vitamin K like dark green leafy vegetables, while taking

Answer and Explanation

Correct Answer : A,C,D

The correct answers are:

A. You may start taking warfarin while still on heparin when you are getting ready to be discharged home.

Warfarin takes several days to reach therapeutic levels, so patients often overlap with heparin until the INR (International Normalized Ratio) reaches the target range (typically 2.0-3.0 for most conditions).

C. Use a soft-bristled toothbrush and avoid brushing too aggressively.

Warfarin increases the risk of bleeding, so using a soft toothbrush helps prevent gum bleeding.

D. You should replace straight razors with an electric shaver to avoid cuts.

Since warfarin thins the blood, small cuts can lead to excessive bleeding. An electric shaver reduces the risk of accidental cuts.

B. You will need to have your aPTT monitored frequently while on Warfarin. (Incorrect)

Warfarin is monitored using INR and PT (Prothrombin Time), not aPTT.
aPTT (Activated Partial Thromboplastin Time) is used to monitor heparin therapy, not warfarin.

E. Increase foods high in vitamin K like dark green leafy vegetables while taking Warfarin. (Incorrect)

Vitamin K counteracts warfarin's effects, so patients should keep their vitamin K intake consistent rather than increasing it.

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Correct Answer is B

Explanation

A. The blockage is most likely in the right parietal region:
While a facial droop and weakness can be indicative of a stroke, the specific location of the blockage cannot be definitively determined based on the symptoms alone. A right-sided facial droop suggests that the lesion or event likely involves the left side of the brain, particularly the frontal or temporal regions, as these areas are typically associated with facial motor control. A parietal lesion would more commonly result in sensory deficits or spatial issues, not primarily facial droop. Therefore, this statement is not correct in this case.

B. This type of event can be one of the primary warning signs of a future stroke:
The client’s presentation of unilateral facial droop and weakness that resolves spontaneously within an hour is highly consistent with a transient ischemic attack (TIA). A TIA, often referred to as a "mini-stroke," is characterized by temporary neurological deficits that resolve without permanent damage. TIAs are considered warning signs of a potential future stroke, and the client should be evaluated promptly to address risk factors and prevent a more serious, permanent stroke.

C. The signs and symptoms are most consistent with an acute hemorrhagic stroke:
An acute hemorrhagic stroke typically presents with sudden and severe neurological deficits, such as a severe headache, vomiting, and loss of consciousness. Hemorrhagic strokes do not typically resolve spontaneously within an hour. The client's symptoms (unilateral facial droop and weakness that resolve within an hour) are more indicative of a TIA, not a hemorrhagic stroke. A hemorrhagic stroke would likely result in sustained deficits and a more urgent clinical presentation.

D. The signs and symptoms are most consistent with a focal awareness seizure:
Focal awareness seizures (previously known as simple partial seizures) generally involve abnormal electrical activity in a specific area of the brain, leading to symptoms such as motor twitches or sensory disturbances, but not typically a full facial droop or weakness. These seizures do not cause symptoms that resolve in such a short time, nor do they present with unilateral weakness in the manner described here. Therefore, this scenario is not consistent with a seizure disorder.

A. "Following up with your dentist frequently will be important. B. Take an ant acid with the medication if indigestion occurs. C. *Alcoholic beverages should be limited to 1-2 per day while taking phenytoin.* D. "Phenytoin may turn your urine orange

Correct Answer is A

Explanation

A. "Following up with your dentist frequently will be important.":
This is the correct and important advice to give. Phenytoin (Dilantin), an anticonvulsant, can cause gum overgrowth (gingival hyperplasia), which makes it important for the patient to have regular dental check-ups. Poor oral hygiene combined with gingival hyperplasia can increase the risk of infection and other oral health issues. Therefore, advising the patient to follow up frequently with a dentist is essential to manage this side effect.

B. "Take an antacid with the medication if indigestion occurs.":
advice. Taking an antacid with phenytoin can interfere with its absorption. Antacids, especially those containing aluminum or magnesium, can reduce the effectiveness of phenytoin, leading to suboptimal therapeutic levels. It’s important to separate phenytoin from antacids by at least 2 hours to avoid this interaction. Therefore, antacids should not be used with phenytoin to manage indigestion.

C. "Alcoholic beverages should be limited to 1-2 per day while taking phenytoin.":
This is inaccurate advice. Alcohol can significantly affect the metabolism of phenytoin, increasing the risk of both toxicity and reduced effectiveness. Alcohol may lower the seizure threshold and interfere with the therapeutic effect of phenytoin, especially in higher amounts. Therefore, it is generally recommended that patients taking phenytoin avoid alcohol altogether, or at the very least limit consumption significantly and discuss it with their healthcare provider.

D. "Phenytoin may turn your urine orange.":
information. Phenytoin does not cause urine to turn orange. Urine discoloration can occur with some medications (like rifampin, for example), but not with phenytoin. This statement could cause unnecessary confusion for the patient. It is essential to provide accurate information to avoid misconceptions about medication side effects.

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A nurse is providing education for client newly prescribed warfarin in preparation for being discharged home. Which of the following should be included the teaching plan? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who presented with unilateral facial droop and weakness that lasted for about an hour before resolving spontaneausly without intervention. Which of the following is true regarding this situation?

Correct Answer is B

Explanation

A nurse is providing teaching to a client who has seizures and a new prescription for phenytoin. Which of the following information should the nurse provide?

Correct Answer is A

Explanation

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