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A nurse is caring for a client who has deep vein thrombosis. The client has been receiving IV heparin for the past 5 days and now has a new prescription for oral warfarin in addition to the heparin. The client asks the nurse if both medications are necessary. Which of the following is an appropriate response by the nurse?
- A. “Both heparin and warfarin work together to dissolve the clots.â€
- B. “I will ask the charge nurse to call your provider and get an explanation.â€
- C. “Heparin enhances the effects of the warfarin.â€
- D. “Heparin will be continued until the warfarin reaches a therapeutic level.â€
- G. D
Correct Answer: Heparin and warfarin prevent clot growth, not dissolution. No enhancement occurs. Heparin bridges until warfarin's therapeutic level is reached, typically 3 days.
Rationale: Correct Answer: D. "Heparin will be continued until the warfarin reaches a therapeutic level."
Rationale:
1. Heparin and warfarin work differently: Heparin prevents new clots, while warfarin stabilizes existing clots.
2. Transition period: Heparin is continued initially to prevent clotting while warfarin reaches its full anticoagulant effect.
3. Therapeutic level: Warfarin takes time to reach its target level for optimal clot prevention.
4. No clot dissolution: Neither heparin nor warfarin directly dissolve clots; they prevent further clot formation.
Summary of other choices:
A: Incorrect. Misleading information about clot dissolution.
B: Incorrect. Unnecessary escalation without clarifying the situation.
C: Incorrect. Misconception about the relationship between heparin and warfarin.
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A nurse is reinforcing teaching with a client who has a new prescription for buspirone (Buspar) to treat anxiety. Which of the following information should the nurse include?
- A. Take this medication on an empty stomach.
- B. Expect optimal effects within 24 hours.
- C. This medication has a low risk for dependency.
- D. Take this medication on an as-needed basis for anxiety.
- G. C
Correct Answer: No empty stomach requirement. Effects take weeks, not 24 hours. Low dependency risk is key. It's not for as-needed use.
Rationale: Correct Answer: C: This medication has a low risk for dependency.
Rationale:
1. Buspirone (Buspar) is a non-benzodiazepine anxiolytic with a lower risk of dependency compared to benzodiazepines.
2. Educating the client about the low dependency risk is crucial to alleviate fears and promote adherence.
3. Option A is incorrect as buspirone can be taken with or without food.
4. Option B is incorrect as the full therapeutic effects of buspirone may take several weeks to manifest, not within 24 hours.
5. Option D is incorrect as buspirone is typically taken regularly, not on an as-needed basis for anxiety.
Summary:
- Choice A is incorrect because buspirone can be taken with or without food.
- Choice B is incorrect because optimal effects of buspirone may take weeks, not 24 hours.
- Choice D is incorrect because buspirone is typically taken regularly, not on an
A patient is allergic to penicillin. Which class of antibiotics might they also have a cross-allergy to?
- A. Cephalosporins
- B. Sulfonamides
- C. Macrolides
- D. Aminoglycosides
- G. A
Correct Answer: Cephalosporins share a similar structure with penicillin, risking cross-allergy. Sulfonamides, macrolides, and aminoglycosides lack this relation.
Rationale: The correct answer is A: Cephalosporins. Cephalosporins have a beta-lactam ring structure similar to penicillin, leading to potential cross-allergy. Sulfonamides, macrolides, and aminoglycosides have different chemical structures, reducing the likelihood of cross-allergy. Therefore, individuals allergic to penicillin may have a cross-allergy to cephalosporins due to structural similarity, making it the correct choice.
The nurse is caring for a patient who is experiencing anaphylaxis. The family asks the nurse why the patient is having difficulty breathing. The nurse responds based on what knowledge?
- A. Bronchoconstriction in response to the allergen.
- B. Compensation for a rapid fall in blood pressure.
- C. Reflex tachycardia.
- D. Seizures are likely to occur.
- G. A
Correct Answer: Bronchoconstriction from allergens causes breathing difficulty in anaphylaxis. Hypotension, tachycardia, and seizures are secondary or unrelated.
Rationale: The correct answer is A: Bronchoconstriction in response to the allergen. During anaphylaxis, the body releases histamine causing bronchoconstriction, leading to difficulty breathing. This is a direct response to the allergen and can lead to respiratory distress. Choice B, compensation for a rapid fall in blood pressure, is incorrect as hypotension is a secondary effect of anaphylaxis. Choice C, reflex tachycardia, is also incorrect as tachycardia is a compensatory response to hypotension, not the cause of difficulty breathing. Choice D, seizures are likely to occur, is incorrect as seizures are not a common manifestation of anaphylaxis. Therefore, the correct answer is A as it directly relates to the pathophysiology of anaphylaxis.
In which of the following conditions should decongestants be used with caution?
- A. Diabetes
- B. Hypertension
- C. Allergic rhinitis
- D. Hyperthyroidism
- G. B
Correct Answer: Diabetes isn't a primary caution. Hypertension risks elevation from vasoconstriction. Allergic rhinitis is a treatment target. Hyperthyroidism and heart disease (E) also require caution, but B is listed correct.
Rationale: The correct answer is B: Hypertension. Decongestants can lead to vasoconstriction and elevate blood pressure, posing a risk for individuals with hypertension. Diabetes (A) is not a primary concern with decongestants. Allergic rhinitis (C) is a condition where decongestants are often used as a treatment. Hyperthyroidism (D) can have cardiovascular effects and should also be used with caution. However, the primary caution for decongestant use is hypertension due to the potential for exacerbating high blood pressure.
According to an evidence-based approach, what is the most productive way to treat anxiety disorders?
- A. Provide the client with a powerful medication.
- B. Uncover and address the cause of anxiety.
- C. Allow the client to self-medicate with OTC medications.
- D. Immediately start multiple-drug therapy.
- G. B
Correct Answer: Medication alone isn't most productive. Cognitive behavioral therapy addressing anxiety causes is evidence-based. Self-medication and multiple drugs initially are not recommended.
Rationale: The correct answer is B: Uncover and address the cause of anxiety. An evidence-based approach for treating anxiety disorders involves cognitive behavioral therapy (CBT) to address the underlying causes of anxiety. By identifying and working through the root causes of anxiety, clients can develop coping strategies and long-term solutions. Providing powerful medications (A) may only offer temporary relief and not address the underlying issues. Allowing self-medication with OTC medications (C) can be dangerous and lead to misuse. Immediately starting multiple-drug therapy (D) can increase the risk of side effects and interactions without addressing the root cause of anxiety. Thus, focusing on uncovering and addressing the causes of anxiety through CBT is the most productive and evidence-based approach.