The nurse is preparing discharge teaching for a client following placement of a mechanical aortic valve. Which information regarding warfarin(coumadin) therapy would the nurse include? Select all that apply.

Use a soft bristle toothbrush

Risk of infection is increased

Check for black, tarry stools

Limit aspirin to 650mg/day

Keep appointments for PT/INR monitoring

Answer and Explanation

Correct Answer : A,C,E

a.   Use a soft bristle toothbrush: Warfarin (Coumadin) therapy can increase the risk of bleeding. Using a soft bristle toothbrush can help reduce the risk of gum bleeding or oral mucosal injury, which is important for clients on anticoagulant therapy.
b.   Risk of infection is increased: There is no direct association between warfarin therapy and an increased risk of infection. This option is not relevant to warfarin therapy.
c.   Check for black, tarry stools: Warfarin therapy increases the risk of gastrointestinal bleeding. Black, tarry stools can indicate upper gastrointestinal bleeding, which requires immediate medical attention.
d.   Limit aspirin to 650mg/day: Aspirin is typically avoided or used cautiously in combination with warfarin due to an increased risk of bleeding. However, there is no specific recommended limit of 650mg/day for aspirin use in conjunction with warfarin. This option does not accurately reflect guidance for warfarin therapy.
e.   Keep appointments for PT/INR monitoring: Prothrombin time (PT) and international normalized ratio (INR) monitoring are essential for assessing the effectiveness and safety of warfarin therapy. PT/INR levels need to be within the therapeutic range to prevent both clotting and bleeding complications. Keeping appointments for monitoring ensures timely adjustments to the warfarin dosage.

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Correct Answer is B

Explanation

a. Review I&O (Intake and Output): While reviewing intake and output is an essential component of assessing fluid status in heart failure, it is not the immediate priority in this scenario. The client's presentation with dyspnea and crackles suggests acute respiratory distress, which requires immediate assessment and intervention to address potential hypoxemia.

b. Check pulse oximetry: In a client presenting with elevated blood pressure, dyspnea, and bilateral crackles throughout lung fields, the priority intervention is to assess oxygenation status. Checking pulse oximetry provides immediate information about the client's oxygen saturation levels, which is crucial for determining the severity of respiratory distress and guiding subsequent interventions. Hypoxemia is a common complication in heart failure exacerbations and can worsen symptoms such as dyspnea and respiratory distress.

c. Administer digoxin: Digoxin is a medication commonly used in the management of heart failure to improve cardiac output and reduce heart rate. However, it is not the priority intervention in this scenario. Assessing oxygenation status and addressing respiratory distress take precedence over administering medications.

d. Obtain 12-lead ECG: While obtaining a 12-lead ECG is important for assessing cardiac rhythm and identifying any potential cardiac abnormalities, it is not the immediate priority in this scenario. The client's presentation with acute respiratory distress warrants immediate assessment of oxygenation status to guide appropriate interventions.

A. Serum potassium 3.1 mEq/L (3.5-5.0 mEq/L) B. Patient reports abdominal pain C. Patient does not have a foley catheter D. Blood pressure 132/70

Correct Answer is A

Explanation

a. Serum potassium 3.1 mEq/L (3.5-5.0 mEq/L): Furosemide (a loop diuretic) can cause potassium loss (hypokalemia). A potassium level of 3.1 mEq/L is below the normal range, and administering Furosemide could further decrease potassium levels. The nurse should question giving the medication and consider potassium supplementation.

b. Patient reports abdominal pain:Abdominal pain is not directly related to Furosemide administration. While it's essential to assess the cause of pain, it doesn't specifically impact the decision to administer Furosemide.

c. Patient does not have a foley catheter: The absence of a foley catheter is not a contraindication for Furosemide administration. It's unrelated to the medication's safety or effectiveness.

d. Blood pressure 132/70: The blood pressure reading falls within a normal range. Furosemide is commonly used to manage hypertension and fluid overload in heart failure patients. This blood pressure reading does not raise concerns about administering Furosemide.

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The nurse is preparing discharge teaching for a client following placement of a mechanical aortic valve. Which information regarding warfarin(coumadin) therapy would the nurse include? Select all that apply.

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Naxlex Comprehensive Predictor Exams

A client with a history of heart failure presents to the emergency department with elevated blood pressure, dyspnea and bilateral crackles throughout lung fields. Which intervention would the nurse implement first?

Correct Answer is B

Explanation

A client with heart failure is scheduled to receive 40 mg of Furosemide IV push. Which data would cause the nurse to question administering this medication?

Correct Answer is A

Explanation

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