A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate?
"Enoxaparin will work right away, but warfarin takes several days to begin preventing clots."
"Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from forming"
"Because of the risk for a blood clot in the lungs, it is important for you to take more than one blood thinner."
"Taking both blood thinners greatly reduces the risk for another clot to form."
The Correct Answer is A
Rationale:
A. Enoxaparin, a low molecular weight heparin, provides immediate anticoagulation by inhibiting factor Xa. Warfarin works by inhibiting vitamin K–dependent clotting factors but takes 3–5 days to reach therapeutic effect, so both drugs are overlapped until warfarin is effective.
B. Neither enoxaparin nor warfarin dissolves an existing clot; instead, they prevent clot propagation and new clot formation. Clot resolution occurs naturally through the body’s fibrinolytic system.
C. The dual therapy is not used because of clot location risk, but rather because of the pharmacokinetics of the two medications. The overlap ensures continuous anticoagulation until warfarin becomes therapeutic.
D. Using two anticoagulants together does not provide additive long-term protection. The overlap is temporary, serving to maintain anticoagulation until warfarin reaches therapeutic levels, after which enoxaparin is discontinued.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Doxycycline: Doxycycline is an antibiotic used to treat bacterial infections. It has no role in the management or prevention of peripheral artery disease and does not affect atherosclerotic plaque or vascular health.
B. Apixaban: Apixaban is an anticoagulant used to prevent thromboembolic events in conditions such as atrial fibrillation or venous thromboembolism. While it affects clotting, it is not a standard therapy for managing the underlying atherosclerosis in peripheral artery disease.
C. Atorvastatin: Atorvastatin is a statin that lowers LDL cholesterol and stabilizes atherosclerotic plaques. It reduces the risk of cardiovascular events and is a cornerstone in the pharmacologic management of peripheral artery disease, helping improve long-term vascular outcomes.
D. Enoxaparin: Enoxaparin is a low molecular weight heparin used for acute anticoagulation and prevention of deep vein thrombosis. It is not routinely indicated for chronic management of peripheral artery disease unless there is a specific thrombotic complication.
Correct Answer is D
Explanation
Rationale:
A. Ambulating soon after surgery: Early ambulation promotes circulation, reduces venous stasis, and is one of the safest and most effective ways to prevent VTE after surgery.
B. Elevating her feet: Elevation supports venous return to the heart, decreases pooling of blood in the lower extremities, and reduces the risk of clot formation.
C. Flexing her ankles: Ankle flexion exercises encourage calf muscle contraction, enhance blood flow, and prevent venous stasis, making them beneficial for VTE prevention.
D. Massaging her legs: Massaging the legs of a client at risk for VTE can dislodge an existing clot, increasing the risk of pulmonary embolism, which makes it unsafe.
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