A patient is admitted to the hospital and will begin taking levothyroxine (Synthroid). You learn that the patient also takes warfarin (Coumadin). You will notify the provider to discuss ________ the ________ dose.
reducing levothyroxine
reducing warfarin
increasing: levothyroxine
increasing warfarin
The Correct Answer is D
A. Levothyroxine dosing is based on thyroid hormone levels and patient response. The interaction with warfarin does not require reducing levothyroxine; in fact, reducing it unnecessarily could lead to hypothyroidism.
B. Levothyroxine increases the metabolism of vitamin K-dependent clotting factors, which can enhance the anticoagulant effect of warfarin. Reducing warfarin preemptively is not recommended without monitoring, as dose adjustments should be guided by INR results.
C. There is no interaction that necessitates increasing levothyroxine when warfarin is used. Thyroid dosing is independent of warfarin therapy.
D. Starting levothyroxine in a patient taking warfarin can enhance warfarin’s anticoagulant effect, increasing the risk of bleeding. In practice, the provider may need to adjust warfarin dosing based on INR monitoring, especially during the initial weeks after starting or changing levothyroxine. The nurse should notify the provider so INR can be closely monitored and warfarin dosage adjusted accordingly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["50"]
Explanation
Step 1: Use the formula
Flow rate (gtt/min) = (mL/hr × Drop factor) ÷ 60
Step 2: Insert values
Flow rate = (150 × 20) ÷ 60
Step 3: Calculate
Flow rate = 3,000 ÷ 60
Flow rate = 50 gtt/min
Step 4: Round to nearest whole number
50 → 50 gtt/min
Final Answer: 50 gtt/min
Correct Answer is ["A","B","C","D","E"]
Explanation
A. Rest, especially lying flat, can help relieve post-dural puncture headaches (spinal headaches) by reducing cerebrospinal fluid (CSF) pressure. Patients are often encouraged to limit upright activity until symptoms improve.
B. Fluidshelp maintain hydration, which may support CSF volume and circulation, potentially alleviating headache symptoms.
C. A blood patchis considered the most definitive treatment for persistent or severe spinal headaches. It involves injecting the patient’s own blood into the epidural space near the puncture site to seal the leak of CSF, which provides rapid and often complete relief.
D. Caffeinecan provide temporary relief for spinal headaches. It works as a vasoconstrictorand may increase CSF production, reducing headache intensity. Caffeine can be administered orally or intravenously.
E. Analgesics, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can be used to manage pain and discomfortassociated with spinal headaches. Opioids are generally avoided unless severe and other measures are ineffective.
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