A patient with hepatitis E is admitted to a medical-surgical unit. The nurse teaches the patient and their family that this type of hepatitis spread through which mode of transmission?

Answer: D

Rationale:

A) A renal ultrasound: A renal ultrasound is not typically used to confirm a diagnosis of hypertension. While renal artery stenosis can contribute to hypertension in some cases, it is not the primary diagnostic test for hypertension.

B) A cardiac stress test: A cardiac stress test is not used to confirm a diagnosis of hypertension. It is primarily used to assess cardiovascular function and detect coronary artery disease or cardiac arrhythmias.

C) A manual blood pressure cuff: While manual blood pressure measurements can provide accurate readings, they are subject to potential inaccuracies due to factors such as observer bias and white coat syndrome. Therefore, they may not be the most reliable method for confirming a diagnosis of hypertension.

D) Ambulatory blood pressure measurement: Ambulatory blood pressure measurement involves obtaining multiple blood pressure readings over a 24-hour period using a portable monitor. It is considered the gold standard for diagnosing hypertension, as it provides a more comprehensive assessment of blood pressure variability and reduces the impact of white coat syndrome. Therefore, it is the preferred diagnostic test in this scenario to confirm whether the patient has hypertension outside of the clinical setting.

A. "Warfarin takes several days to work, so the heparin will be used until the warfarin reaches a therapeutic level":
This response is correct because warfarin, an oral anticoagulant, takes several days to reach its full therapeutic effect due to its mechanism of action on vitamin K-dependent clotting factors. Therefore, heparin, which has an immediate onset of action, is used concurrently to prevent new clot formation until warfarin reaches therapeutic levels. Once warfarin reaches its therapeutic range, heparin is typically discontinued.

B. "The heparin increases the effects of the warfarin and decreases the length of your hospital stay":
This statement is incorrect. While heparin and warfarin both act as anticoagulants, they have different mechanisms of action. Heparin works rapidly by inhibiting thrombin, while warfarin acts more slowly by inhibiting vitamin K-dependent clotting factors. The concurrent use of heparin and warfarin is not to increase the effects of warfarin but rather to bridge the gap until warfarin reaches therapeutic levels.

C. "I will call the provider to discontinue the heparin":
Discontinuing heparin without a clear order from the provider could be inappropriate and potentially dangerous. Abrupt discontinuation of heparin before warfarin reaches therapeutic levels could increase the risk of thrombus formation or embolization. The decision to discontinue heparin should be made by the provider based on the patient's individual clinical status and response to therapy.

D. "Both medications work together to dissolve the clots":
While both heparin and warfarin are anticoagulants used to prevent further clot formation and propagation, they do not directly dissolve existing clots. Instead, they prevent the formation of new clots and allow the body's natural fibrinolytic system to gradually break down existing clots. Therefore, this statement is not entirely accurate in describing the mechanism of action of these medications.