A patient is being discharged soon on warfarin (Coumadin). What menu selection for dinner indicates that the patient may need more education regarding this medication?

Tuna salad and chips

Chicken tacos

Barley soup

Large chef’s salad and muffin

Answer and Explanation

The Correct Answer is D

Choice A reason: Tuna salad and chips are generally safe for patients on warfarin. These foods have low vitamin K content, which does not significantly affect warfarin’s anticoagulant effect. Warfarin inhibits vitamin K-dependent clotting factors, and consistent low-vitamin K intake supports stable INR levels, making this choice appropriate.

Choice B reason: Chicken tacos are unlikely to interfere with warfarin. Chicken and typical taco ingredients (e.g., lettuce, tomatoes) have minimal vitamin K. Maintaining a consistent diet with low-vitamin K foods prevents fluctuations in warfarin’s efficacy, as high vitamin K can counteract its anticoagulant effects. This choice does not indicate a need for education.

Choice C reason: Barley soup is safe for warfarin patients, as barley contains negligible vitamin K. Soups without high-vitamin K vegetables (e.g., spinach) do not significantly impact warfarin’s inhibition of clotting factors. Consistent dietary vitamin K intake is key, and this choice aligns with maintaining stable anticoagulation, requiring no additional patient education.

Choice D reason: A large chef’s salad may include high-vitamin K foods like spinach, kale, or broccoli, which counteract warfarin’s anticoagulant effect by promoting clotting factor synthesis. This could destabilize INR, increasing clotting risk. The patient needs education on avoiding high-vitamin K foods to maintain therapeutic anticoagulation, making this choice problematic.

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Correct Answer is B

Explanation

Choice A reason: Cushing’s syndrome, caused by cortisol excess, leads to fluid retention and hypertension, not high urine output. Post-craniotomy, excessive urine output suggests pituitary dysfunction, not cortisol overproduction. Cushing’s does not cause polyuria; instead, it may reduce urine output due to water retention, making this diagnosis unlikely.

Choice B reason: Diabetes insipidus (DI) is likely post-craniotomy due to pituitary or hypothalamic damage, impairing antidiuretic hormone (ADH) secretion. This causes inability to concentrate urine, leading to excessive dilute urine output (e.g., 1,500 mL/hour). DI’s hallmark is polyuria, matching the patient’s symptoms, requiring urgent ADH replacement and fluid management.

Choice C reason: Adrenal crisis causes hypotension, hyponatremia, and reduced urine output due to aldosterone deficiency and dehydration. High urine output is not a feature, as adrenal insufficiency leads to volume depletion, not polyuria. Post-craniotomy, pituitary-related conditions like DI are more likely than adrenal dysfunction in this scenario.

Choice D reason: SIADH causes water retention due to excessive ADH, leading to low urine output and concentrated urine. The patient’s high urine output (1,500 mL/hour) is opposite to SIADH’s oliguria. Post-craniotomy, DI is more common due to pituitary injury, making SIADH an incorrect diagnosis for this presentation.

A. Respiratory failure B. Diabetes C. Sepsis D. Heart attack

Correct Answer is C

Explanation

Choice A reason: Respiratory failure is a concern in peritonitis if abdominal distension impairs diaphragm movement, but it is not the highest priority. Sepsis, from bacterial spread, poses a more immediate life-threatening risk, causing systemic inflammation and shock. Monitoring respiratory status is secondary to addressing the infectious source driving peritonitis complications.

Choice B reason: Diabetes is not a direct complication of peritonitis. While it may complicate management by predisposing to infections, peritonitis itself does not cause diabetes. Sepsis is the primary concern, as bacterial peritonitis can rapidly progress to systemic infection, requiring urgent antibiotics and monitoring to prevent multi-organ failure.

Choice C reason: Sepsis is the highest priority in peritonitis, as bacterial contamination from gastrointestinal perforation or infection can lead to systemic inflammatory response syndrome, shock, and organ failure. Early recognition of fever, tachycardia, and hypotension is critical to initiate antibiotics and fluids, preventing mortality in this life-threatening complication of peritonitis.

Choice D reason: Heart attack is not a primary complication of peritonitis. While sepsis may strain the cardiovascular system, increasing myocardial demand, peritonitis itself does not cause coronary occlusion. Sepsis is the more immediate threat, as it drives systemic inflammation and shock, requiring urgent intervention to prevent progression to multi-organ dysfunction.

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A patient is being discharged soon on warfarin (Coumadin). What menu selection for dinner indicates that the patient may need more education regarding this medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What should the nurse suspect when hourly assessment of urine output on a patient post-craniotomy exhibits a urine output from a catheter of 1,500 mL for two consecutive hours?

Correct Answer is B

Explanation

A nurse is providing care for a patient who has peritonitis. Which of the following conditions is the highest priority for the nurse to monitor?

Correct Answer is C

Explanation

A nurse is caring for a patient with acute peritonitis. Which intervention would the nurse expect to see?

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