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.

Answer and Explanation

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.

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Correct Answer is B

Explanation

Choice A rationale

Fewer doses of insulin may not necessarily be required with frequent self-monitoring of blood glucose. The need for insulin is determined by blood glucose levels, not the frequency of monitoring.

Choice B rationale

Frequent self-monitoring of blood glucose assists in gaining control over glucose levels. It can immediately tell you the effects of food choices, physical activity, and medication on blood glucose control.

Choice C rationale

While good blood glucose control can help minimize other health problems, frequent self- monitoring of blood glucose does not directly minimize other health problems.

Choice D rationale

Frequent self-monitoring of blood glucose is not necessarily the most cost-efficient method for glucose control. The cost efficiency depends on various factors, including the cost of testing supplies and the frequency of testing.

A. Increase the nighttime insulin glargine dose. B. Ensure a snack is consumed at bedtime. C. Check the morning cortisol level. D. Check the glucose level at 2 a.m. and 8 a.m.

Correct Answer is B

Explanation

Choice A rationale

Increasing the nighttime insulin glargine dose may exacerbate the Somogyi effect, a phenomenon where the blood sugar level drops too low overnight, causing a rebound high blood sugar level in the morning.

Choice B rationale

Consuming a snack at bedtime can help prevent the blood sugar level from dropping too low overnight, thus preventing the Somogyi effect.

Choice C rationale

Checking the morning cortisol level is not directly related to managing the Somogyi effect.

Choice D rationale

Checking the glucose level at 2 a.m. and 8 a.m. can help identify the Somogyi effect, but it does not prevent it.

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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?

Choice B rationale

Choice C rationale

Choice D rationale

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse explains to a patient diagnosed with diabetes mellitus that the major benefit of frequent self-monitoring of blood glucose is that:

Correct Answer is B

Explanation

Choice B rationale

Choice C rationale

Choice D rationale

A Type 1 diabetic client with a morning (fasting) glucose of 260 mg/dL has been diagnosed with the Somogyi effect from insulin administration. What intervention should the nurse anticipate including in the plan of care?

Correct Answer is B

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

The nurse is explaining to a patient why oral antihyperglycemic agents are not effective in Type 1 diabetes. What is the reason?

The nurse is evaluating the patient’s response to antibiotic therapy. Which data would indicate that the medication has been effective?

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