A patient who takes warfarin (Coumadin) is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. Dipstick urinalysis is normal. The patient does not have any signs of bleeding and does not complain of pain. The nurse will anticipate an order for:

vitamin K (phytonadione)

protamine sulfate

a PTT lab test

an INR lab test

Answer and Explanation

The Correct Answer is A

Choice A reason:
Vitamin K (phytonadione) is the antidote for warfarin overdose. It works by promoting the synthesis of clotting factors that are inhibited by warfarin, thereby reversing the anticoagulant effects. In cases of excessive warfarin intake, administering vitamin K helps restore normal clotting function.

Choice B reason:
Protamine sulfate is the antidote for heparin overdose, not warfarin. It works by neutralizing the anticoagulant effects of heparin, but it has no effect on warfarin-induced anticoagulation. Therefore, it is not appropriate for this situation.

Choice C reason:
A PTT lab test measures the effectiveness of the intrinsic pathway of coagulation and is primarily used to monitor heparin therapy. It is not relevant for managing warfarin overdose, as warfarin affects the extrinsic pathway, which is measured by the PT/INR test.

Choice D reason:
While an INR lab test is essential for monitoring the therapeutic levels of warfarin, the immediate need in this situation is to reverse the effects of the overdose. Administering vitamin K is the necessary intervention to counteract the excessive anticoagulation caused by warfarin.

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Correct Answer is C

Explanation

Choice A reason:
Amoxicillin is an antibiotic used to treat bacterial infections. It has no role in the management of atrial fibrillation, which is a cardiac rhythm disorder. Antibiotics do not address the prevention of thromboembolism or the control of heart rate or rhythm.

Choice B reason:
Reglan (metoclopramide) is a medication used to treat gastroesophageal reflux disease (GERD) and gastroparesis. It does not have any indication for use in atrial fibrillation. The management of atrial fibrillation focuses on rate or rhythm control and anticoagulation.

Choice C reason:
Rivaroxaban (Xarelto) is an anticoagulant that is commonly prescribed for patients with atrial fibrillation to prevent stroke and systemic embolism. Since atrial fibrillation increases the risk of thromboembolism, anticoagulation is a crucial component of the treatment plan to reduce the risk of stroke.

Choice D reason:
Omeprazole is a proton pump inhibitor used to treat acid-related stomach issues such as GERD. It is not relevant to the management of atrial fibrillation. The primary concerns in managing atrial fibrillation are controlling the heart rate and preventing thromboembolism, which omeprazole does not address.

A. Blood product transmission B. Perinatal transmission to fetus C. Airborne transmission D. Sexual transmission

Correct Answer is ["A","B","D"]

Explanation

Choice A reason:
HIV can be transmitted through blood products. This mode of transmission occurs when contaminated blood, used in transfusions or other medical procedures, carries the virus to another person. It is one of the primary ways HIV spreads, especially before strict blood screening protocols were implemented.
Choice B reason:
Perinatal transmission refers to the transmission of HIV from a mother to her fetus during pregnancy, childbirth, or breastfeeding. This is a significant mode of transmission, particularly in regions with high HIV prevalence and limited access to antiretroviral therapy.
Choice C reason:
This choice is incorrect because HIV is not transmitted through airborne means. Unlike respiratory viruses, HIV requires direct contact with certain body fluids for transmission. Airborne transmission would imply that the virus could spread through the air, which is not the case with HIV.
Choice D reason:
Sexual transmission is a major route for HIV spread. The virus is present in bodily fluids such as semen, vaginal fluids, and rectal fluids. Unprotected sexual contact allows the virus to pass from one person to another, making this a crucial mode of HIV transmission.

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Naxlex Comprehensive Predictor Exams

A patient is newly diagnosed with atrial fibrillation and is being discharged home today. Their heart rate is controlled at 88 bpm and BP is 121/68. They deny dizziness or fatigue. What medication do we expect this patient will be discharged home with?

Correct Answer is C

Explanation

Which modes of transmission occur with HIV infection? (Select all that apply)

Correct Answer is ["A","B","D"]

Explanation

A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?

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The signs and symptoms of large bowel obstruction are:

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