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 A

Explanation

a. Kussmaul respirations: Metabolic acidosis leads to an accumulation of acids in the body, resulting in compensatory hyperventilation to try to decrease the levels of carbon dioxide and increase pH. Kussmaul respirations are deep, rapid, and labored breathing patterns characteristic of this compensation mechanism.

b. Muscle spasms: While muscle spasms can occur in various conditions, they are not specific to metabolic acidosis. Other factors, such as electrolyte imbalances or dehydration, may cause muscle spasms.

c. Paresthesia in fingers: Paresthesia (tingling or numbness) in the fingers can occur due to metabolic acidosis. Acidosis affects nerve function, leading to abnormal sensations in the extremities. It is not specific to metabolic acidosis.

d. Tinnitus: Tinnitus is not typically associated with metabolic acidosis. It is more commonly associated with conditions such as ototoxicity, Meniere's disease, or vascular disorders affecting the inner ear.

A. Decreasing level of consciousness B. Bradycardia C. Fever D. ABG: Ph 7.31 (7.35-7.45), PaCO2 42 mmHg (35-45mmHg), HCO3 19 mEq/L (22-26 mEq/L)

Correct Answer is D

Explanation

Decreasing level of consciousness: This assessment finding is consistent with respiratory acidosis, especially if it is severe. In respiratory acidosis, carbon dioxide (CO2) levels in the blood increase, leading to respiratory depression and potential alterations in consciousness due to hypercapnia. Therefore, a decreasing level of consciousness is a possible finding in a client with respiratory acidosis.

b. Bradycardia: Bradycardia is not typically associated with respiratory acidosis. In fact, it is more commonly associated with respiratory alkalosis, where hyperventilation can lead to decreased CO2 levels and subsequent compensatory metabolic alkalosis.

c. Fever: Fever is not a direct consequence of respiratory acidosis. It may occur in response to an underlying infection or inflammation, which could exacerbate respiratory symptoms in a client with COPD. However, it is not a specific finding associated with respiratory acidosis itself.

d. ABG: pH 7.31, PaCO2 42 mmHg, HCO3 19 mEq/L: This ABG result confirms respiratory acidosis. The pH is below the normal range (acidosis), the PaCO2 is elevated (indicating respiratory acidosis), and the HCO3 is decreased (indicating compensation through renal mechanisms). This ABG finding supports the diagnosis of respiratory acidosis in a client with COPD.

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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

The nurse is assessing a client with suspected metabolic acidosis. Which finding would be consistent with this diagnosis?

Correct Answer is A

Explanation

The nurse is admitting a client with COPD and respiratory acidosis. Which assessment finding would the nurse anticipate for this client?

Correct Answer is D

Explanation

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