The nurse is providing teaching to a client who is being discharged with a prescription for warfarin. Which information should be included in the teaching for this medication?
Omit green, leafy vegetables from the diet.
Use over-the-counter pain relief medications.
Obtain laboratory tests as directed.
Use an electric razor for shaving.
Obtain a medical alert bracelet.
The Correct Answer is C
Choice A rationale
While it is true that warfarin’s effectiveness can be affected by vitamin K, found in green leafy vegetables, it is not necessary to completely omit these from the diet. Instead, maintaining a consistent intake of vitamin K can help keep INR levels stable.
Choice B rationale
Over-the-counter pain relief medications, especially those that are nonsteroidal anti- inflammatory drugs (NSAIDs), can increase the risk of bleeding when taken with warfarin. Therefore, this advice is not correct.
Choice C rationale
Regular laboratory tests, specifically the International Normalized Ratio (INR), are crucial when taking warfarin to monitor its effectiveness and adjust the dosage if necessary.
Choice D rationale
Using an electric razor can help prevent cuts and bleeding, which is important because warfarin is a blood thinner. However, this information is not as critical as obtaining regular laboratory tests.
Choice E rationale
Obtaining a medical alert bracelet can be beneficial for individuals taking warfarin, as it can alert healthcare professionals in an emergency situation about the individual’s use of a blood thinner. However, this information is not as critical as obtaining regular laboratory tests.
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Correct Answer is B
Explanation
Choice A rationale
Hypoglycemia, or low blood sugar, can occur after insulin administration. However, the onset of hypoglycemia is not immediate. Insulin aspart, a rapid-acting insulin, has a peak action time of approximately 1-3 hours after administration. Therefore, assessing the patient for signs and symptoms of hypoglycemia at 0800, one hour after administration, may be too early.
Choice B rationale
Assessing the patient for signs and symptoms of hypoglycemia at 0730, 30 minutes after insulin administration, is too early. The peak action time of insulin aspart is approximately 1-3 hours after administration. Therefore, the nurse should start assessing the patient for signs and symptoms of hypoglycemia closer to the time of peak action.
Choice C rationale
Assessing the patient for signs and symptoms of hypoglycemia at 1130, four and a half hours after insulin administration, may be too late. The peak action time of insulin aspart is approximately 1-3 hours after administration. Therefore, the nurse should start assessing the patient for signs and symptoms of hypoglycemia closer to the time of peak action.
Choice D rationale
Assessing the patient for signs and symptoms of hypoglycemia at 1000, three hours after insulin administration, is within the peak action time of insulin aspart. Therefore, this is the most appropriate time to start assessing the patient for signs and symptoms of hypoglycemia.
Correct Answer is C
Explanation
Choice A rationale
Placing the patient back on the heparin infusion and redrawing laboratory values would not be the appropriate next step. The INR of 1.9 is below the therapeutic range of 2.0 - 3.0 for most patients on warfarin. Therefore, the warfarin therapy is not yet fully effective, and there is no need to revert to heparin.
Choice B rationale
Asking the healthcare provider if the patient’s medication can be changed to rivaroxaban would not be the appropriate next step. Rivaroxaban is a different type of anticoagulant and would not necessarily be more effective in this situation.
Choice C rationale
Notifying the healthcare provider and asking if the dose of warfarin can be increased would be the appropriate next step. The INR of 1.9 is below the therapeutic range of 2.0 - 3.0 for most patients on warfarin. Therefore, an increase in the warfarin dose may be necessary to achieve therapeutic anticoagulation.
Choice D rationale
Preparing to administer a dose of Vitamin K subcutaneously would not be the appropriate next step. Vitamin K is used to reverse the effects of warfarin and would be counterproductive in this situation.
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