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 D
Explanation
Choice A rationale
The infectious agent is the pathogen that causes the disease, and the reservoir is where the infectious agent lives and multiplies. Hand washing does not directly intervene between these two links.
Choice B rationale
The mode of transmission is how the infectious agent travels to other people and places, and the portal of entry is the route by which an infectious agent enters a new host. Hand washing does not directly intervene between these two links.
Choice C rationale
The susceptible host is a person who is vulnerable to the disease, and the infectious agent is the pathogen that causes the disease. Hand washing does not directly intervene between these two links.
Choice D rationale
The portal of exit is the route by which an infectious agent escapes or leaves the reservoir, and the mode of transmission is how the infectious agent travels to other people and places. Hand washing directly intervenes between these two links by removing the infectious agent from the hands (portal of exit) and preventing its transmission to other people or surfaces.
Correct Answer is A
Explanation
Step 1 is: According to the information from the search results, regular insulin, such as the 16 units prescribed to the patient, starts working 30 minutes to 1 hour after administration and peaks in 2 to 5 hours. Therefore, the patient should expect the insulin peak 2 to 4 hours after administration.
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