A patient has been receiving warfarin sodium 2.5 mg PO daily for four days and the International Normalized Ratio (INR) is 1.9. What should be the nurse’s next step?
Place the patient back on the heparin infusion and redraw laboratory values.
Ask the healthcare provider if the patient’s medication can be changed to rivaroxaban.
Notify the healthcare provider and ask if the dose of warfarin can be increased.
Prepare to administer a dose of Vitamin K subcutaneously.
The Correct Answer is C
Choice A rationale
Placing the patient back on the heparin infusion and redrawing laboratory values would not be the appropriate next step. The INR of 1.9 is below the therapeutic range of 2.0 - 3.0 for most patients on warfarin. Therefore, the warfarin therapy is not yet fully effective, and there is no need to revert to heparin.
Choice B rationale
Asking the healthcare provider if the patient’s medication can be changed to rivaroxaban would not be the appropriate next step. Rivaroxaban is a different type of anticoagulant and would not necessarily be more effective in this situation.
Choice C rationale
Notifying the healthcare provider and asking if the dose of warfarin can be increased would be the appropriate next step. The INR of 1.9 is below the therapeutic range of 2.0 - 3.0 for most patients on warfarin. Therefore, an increase in the warfarin dose may be necessary to achieve therapeutic anticoagulation.
Choice D rationale
Preparing to administer a dose of Vitamin K subcutaneously would not be the appropriate next step. Vitamin K is used to reverse the effects of warfarin and would be counterproductive in this situation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Activated Partial Thromboplastin Time (aPTT) of 25 is within the normal range (25-35 seconds) and is not directly related to deep vein thrombosis (DVT)89.
Choice B rationale
A D-dimer level of 500 ng/mL is elevated (normal range is typically less than 250 ng/mL), which can indicate the presence of a clot, such as in DVT8910.
Choice C rationale
Prothrombin Time (PT) of 14 seconds is within the normal range (11-13.5 seconds) and is not directly related to DVT89.
Choice D rationale
A platelet count of 148,000 uL is within the normal range (150,000-450,000 uL) and is not directly related to DVT89.
Correct Answer is C
Explanation
Choice A rationale
Elevating the feet for 30 minutes after walking is not specifically beneficial for a patient with peripheral arterial disease (PAD). While elevation can help with conditions like edema, it does not directly address the issues associated with PAD12.
Choice B rationale
Avoiding exercise that increases the heart rate is not the best advice for a patient with PAD. Exercise, including activities that increase heart rate, can actually be beneficial. It can help improve circulation, which is often compromised in PAD12.
Choice C rationale
Continuing to walk to the point of pain is beneficial for patients with PAD. Walking, especially at a high intensity, can help improve symptoms of PAD. It can increase blood flow and oxygen supply to the muscles, which can help manage PAD symptoms.
Choice D rationale
While it’s important to care for any ulcers that develop and seek medical attention, stopping walking altogether if a leg ulcer develops is not necessary. Walking is a low-impact activity that can help improve mobility over time.
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