The patient has been started on warfarin (Coumadin) for deep vein thrombosis. The patient asks when the medication will break up the clots. The nurse's best response would be:

"This medication will not break down clots but will make it less likely that the clot will get larger."

"It will break down the clot within 8 to 12 hours of administration."

"It will take 7 to 10 days for the clot to break down."

"You will need to be on this medication for a long time before it will break down the clot."

Answer and Explanation

The Correct Answer is A

A. "This medication will not break down clots but will make it less likely that the clot will get larger." Warfarin (Coumadin) is an anticoagulant medication that works by inhibiting the synthesis of certain clotting factors in the liver. It does not directly break down existing clots but prevents the formation of new clots and the extension of existing ones. This response provides accurate information about the mechanism of action of warfarin.

B. "It will break down the clot within 8 to 12 hours of administration." This statement is incorrect. Warfarin does not have an immediate effect on existing clots. Its action is primarily preventive, reducing the risk of further clot formation and allowing the body's natural processes to gradually break down existing clots over time.

C. "It will take 7 to 10 days for the clot to break down." While the body's natural processes may start breaking down the clot within this timeframe, warfarin itself does not directly cause the dissolution of clots. This response is partially accurate in terms of the timeline for the body's natural clot resolution but does not specify that warfarin itself is not responsible for clot breakdown.

D. "You will need to be on this medication for a long time before it will break down the clot." This statement is misleading. Warfarin's role is to prevent the formation of new clots and further extension of existing ones rather than directly breaking down clots. Additionally, the duration of warfarin therapy is typically determined based on the individual's risk factors for clot formation, and it may not necessarily correlate with the time it takes for existing clots to resolve.

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Correct Answer is B

Explanation

A. If he misses a dose, he should double the dose at the next scheduled time: This statement is incorrect. Doubling the dose of warfarin after missing a dose can significantly increase the risk of bleeding due to excessive anticoagulation. The nurse should emphasize the importance of taking the medication as prescribed and what to do if a dose is missed, such as contacting the healthcare provider for guidance.

B. The client should use an electric razor while on this medication: This statement is correct. Warfarin is an anticoagulant medication that can increase the risk of bleeding. Therefore, it's essential for patients taking warfarin to avoid activities that may increase the risk of injury or bleeding, such as shaving with a traditional razor that can cause cuts or nicks. Using an electric razor reduces this risk.

C. Mild nosebleeds are common during initial treatment: This statement is not entirely accurate. While warfarin can increase the risk of bleeding, including nosebleeds, it's not necessarily common during the initial treatment phase. However, patients should be aware of signs of bleeding and report them to their healthcare provider promptly.

D. Warfarin increases the risk for deep vein thrombosis: This statement is incorrect. Warfarin is actually prescribed to reduce the risk of blood clots, including deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke, in patients who are at risk for these conditions. It works by inhibiting the formation of blood clots. Therefore, it does not increase the risk of DVT; rather, it decreases it.

A. Use a 22-gauge needle to inject the medication. B. Inject the medication into the abdomen above the level of the iliac crest. C. Massage the injection site after administration of the medication. D. Use a 1-inch needle to inject the medication.

Correct Answer is B

Explanation

A. Use a 22-gauge needle to inject the medication.

This is inappropriate. Subcutaneous injections typically require a smaller gauge needle, usually between 25 to 30 gauge, to minimize tissue damage and discomfort. A 22-gauge needle is too large for subcutaneous injections and is more appropriate for intramuscular injections.

B. Inject the medication into the abdomen above the level of the iliac crest.

This is appropriate. The preferred site for subcutaneous heparin injection is the abdomen, avoiding areas near the umbilicus by at least 2 inches. Injecting above the level of the iliac crest is appropriate as it ensures the medication is administered into the subcutaneous tissue where it can be properly absorbed. The abdomen is chosen due to its ample subcutaneous tissue and relatively few large blood vessels, reducing the risk of bleeding and bruising.

C. Massage the injection site after administration of the medication.

This is inappropriate. Massaging the injection site after administering heparin is not recommended as it can cause bruising and increase the risk of bleeding. Heparin is an anticoagulant, and massaging the site can disrupt the tissue and lead to complications.

D. Use a 1-inch needle to inject the medication.

This is inappropriate. A 1-inch needle is generally used for intramuscular injections, not subcutaneous injections. For subcutaneous injections, a shorter needle (usually 3/8 to 5/8 inch) is sufficient to reach the subcutaneous tissue without penetrating too deeply into muscle tissue.

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The patient has been started on warfarin (Coumadin) for deep vein thrombosis. The patient asks when the medication will break up the clots. The nurse's best response would be:

Nursing Test Bank

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Correct Answer is B

Explanation

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