The nurse is caring for a client receiving an intravenous heparin infusion. The client has a new prescription for warfarin and asks the nurse why he has to be on two medications. What response by the nurse is appropriate?
The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin alone.
Heparin provides anticoagulation while we wait for your blood level of warfarin to reach adequate levels.
These medications work synergistically.
The warfarin is used to obtain an adequate level of anticoagulation when heparin alone is unable to do so.
The Correct Answer is B
Choice A reason: Combining heparin and warfarin does not reduce adverse effects. Heparin risks bleeding and thrombocytopenia, while warfarin adds bleeding risk. The combination is used to bridge therapy until warfarin’s anticoagulant effect is therapeutic, not to minimize side effects, making this statement incorrect.
Choice B reason: Heparin provides immediate anticoagulation by enhancing antithrombin activity, inhibiting thrombin and factor Xa. Warfarin takes 3-5 days to achieve therapeutic INR by inhibiting vitamin K-dependent clotting factors. Heparin bridges this delay, ensuring continuous anticoagulation during warfarin initiation, making this the correct response.
Choice C reason: Heparin and warfarin do not work synergistically. Heparin acts rapidly via antithrombin, while warfarin slowly inhibits clotting factor synthesis. Their effects are independent, used together to maintain anticoagulation during warfarin’s delayed onset, not to enhance each other’s mechanisms, making this inaccurate.
Choice D reason: Warfarin is not used because heparin is insufficient but to provide long-term oral anticoagulation. Heparin is effective but requires IV administration, while warfarin allows outpatient management. The combination ensures anticoagulation during warfarin’s onset, not to compensate for heparin’s inadequacy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Hair loss is not a common side effect of isoniazid, nor is it prevented by pyridoxine. Isoniazid primarily causes hepatotoxicity or neurotoxicity due to its metabolism and pyridoxine depletion. Hair loss may occur with other drugs, but pyridoxine supplementation is unrelated to this effect.
Choice B reason: Pyridoxine (vitamin B6) is given with isoniazid to prevent peripheral neuropathy. Isoniazid depletes pyridoxine by forming inactive complexes, impairing nerve function and causing numbness or tingling. Supplementation restores pyridoxine levels, protecting peripheral nerves while allowing isoniazid to effectively treat tuberculosis by inhibiting mycolic acid synthesis.
Choice C reason: Heart failure is not associated with isoniazid or prevented by pyridoxine. Isoniazid’s primary toxicities are hepatic and neurological. Pyridoxine supports nerve health, not cardiac function, and heart failure is more linked to drugs like anthracyclines, not antitubercular therapy.
Choice D reason: Renal failure is not a common side effect of isoniazid, nor is it prevented by pyridoxine. Isoniazid is metabolized by the liver, and its toxicities include hepatotoxicity and neuropathy. Pyridoxine addresses neurological side effects, not renal function, making this an incorrect choice.
Correct Answer is A
Explanation
Choice A reason: Grapefruit juice inhibits hepatic CYP3A4, increasing plasma levels of statins like simvastatin, which are metabolized by this enzyme. This can lead to toxicity, including myopathy or rhabdomyolysis. Patients on antilipemic therapy must avoid grapefruit juice to prevent excessive drug accumulation and adverse effects.
Choice B reason: Bran muffins, high in fiber, do not significantly interact with antilipemic drugs like statins. Fiber may reduce cholesterol absorption, complementing therapy, but it does not affect drug metabolism or efficacy, making it an irrelevant food interaction to discuss for antilipemic therapy.
Choice C reason: Licorice may cause hypokalemia or hypertension, affecting drugs like diuretics, but it has no major interaction with antilipemics like statins. Its effects on mineralocorticoid activity are unrelated to cholesterol-lowering drug metabolism, making it less relevant for antilipemic therapy education.
Choice D reason: Dairy products do not significantly interact with antilipemic drugs. They may affect absorption of bile acid sequestrants, but statins, the most common antilipemics, are unaffected. Grapefruit juice’s impact on statin metabolism is a more critical drug-food interaction to address with patients.
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