TPN 2,000 mL is ordered to infuse from 1900 to 0700.

Using an IV controller, how many milliliters per hour should be infused?

Choice A rationale

Warfarin is a vitamin K antagonist that inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX, and X. Clients must be instructed to maintain a consistent intake of vitamin K-rich foods, such as leafy green vegetables, to avoid fluctuations in warfarin's anticoagulant effect and to maintain a stable INR.

Choice B rationale

Warfarin therapy itself does not impose driving restrictions. The primary concern is the bleeding risk associated with the medication, which would not typically affect a person's ability to drive. Driving is not a discharge instruction required specifically because of the medication itself.

Choice C rationale

Regular laboratory monitoring of the International Normalized Ratio (INR) is essential to ensure the warfarin dosage is therapeutic and safe. The INR normal range is 0.8-1.2. The therapeutic range for warfarin is typically 2.0-3.0 for most indications. Clients need to understand the importance of these appointments.

Choice D rationale

Warfarin is highly protein-bound and metabolized by the cytochrome P450 enzyme system, making it susceptible to numerous drug-drug interactions. Educating the client about potential interactions with other medications, including over-the-counter drugs, is crucial to prevent either bleeding or clotting episodes.

Choice E rationale

A client's adherence to a medication regimen is significantly enhanced when they understand the purpose of the treatment. Explaining that warfarin prevents dangerous blood clots in conditions like atrial fibrillation or deep vein thrombosis helps the client appreciate the importance of consistent daily dosing.

Choice F rationale

Wearing a Medic Alert bracelet is a critical safety measure for clients on warfarin. In an emergency, this bracelet immediately informs healthcare providers that the person is on an anticoagulant, allowing them to make informed decisions about care and to recognize signs of potential bleeding complications.

Choice A rationale

Cradle cap, or seborrheic dermatitis, is caused by the overproduction of sebum and an overgrowth of Malassezia yeast. Rubbing baby oil on the scalp overnight helps to soften the crusts and scales, making them easier to remove. Shampooing the next morning effectively washes away the loosened scales and excess oil.

Choice B rationale

Using a brush with firm bristles can cause micro-abrasions and trauma to the delicate scalp skin. This can lead to inflammation, secondary infection, and increased discomfort for the infant. A soft-bristled brush or a soft washcloth is recommended for gentle removal of the scales.

Choice C rationale

Dandruff-control shampoos often contain active ingredients like selenium sulfide or zinc pyrithione, which can be too harsh for an infant's sensitive scalp. These chemicals can be absorbed through the skin and cause irritation or systemic effects. They should only be used under a doctor's supervision.

Choice D rationale

While olive oil can help soften the scales, applying it and leaving it on can create a moist, occlusive environment. This can promote the growth of the yeast responsible for cradle cap and potentially worsen the condition. The oil should be washed off after a period of time. .