Nokea
A patient asks the nurse if there are any natural products that would decrease anticoagulant effects. The nurse tells the patient that which of the following natural products causes a decrease in anticoagulant effects?
- A. Horse chestnut
- B. Licorice root
- C. Turmeric
- D. Green tea
Correct Answer: D
Rationale: Green tea is a natural product that would decrease anticoagulant effects. Horse chestnut, licorice root, and turmeric are natural products that would increase anticoagulant effects.
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The health care provider prescribes an infusion of argatroban and daily partial thromboplastin time (PTT) testing for a patient with venous thromboembolism (VTE). Which of the following actions should the nurse include in the plan of care?
- A. Avoid giving any IM medications to prevent localized bleeding.
- B. Discontinue the infusion for PTT values greater than 50 seconds.
- C. Monitor posterior tibial and dorsalis pedis pulses with the Doppler.
- D. Have vitamin K available in case reversal of the argatroban is needed.
Correct Answer: A
Rationale: IM injections are avoided in patients receiving anticoagulation. A PTT of 50 seconds is within the therapeutic range. Vitamin K is used to reverse warfarin. Pulse quality is not affected by VTE.
A patient with a venous thromboembolism (VTE) is started on enoxaparin and warfarin. The patient asks the nurse why two medications are necessary. Which of the following responses by the nurse is accurate?
- A. Administration of two anticoagulants reduces the risk for recurrent venous thrombosis.
- B. Enoxaparin will start to dissolve the clot, and warfarin will prevent any more clots from occurring.
- C. The enoxaparin will work immediately, but the warfarin takes several days to have an effect on coagulation.
- D. Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant.
Correct Answer: C
Rationale: Low-molecular-weight heparin (LMWH) such as enoxaparin has an immediate effect on coagulation and is used until warfarin reaches therapeutic levels, which takes several days.
The nurse is developing a teaching plan for a patient newly diagnosed with peripheral artery disease (PAD). Which of the following information should the nurse include?
- A. Exercise only if you do not experience any pain.
- B. It is very important that you stop smoking cigarettes.
- C. Try to keep your legs elevated whenever you are sitting.
- D. Put on support hose early in the day before swelling occurs.
Correct Answer: B
Rationale: Smoking cessation is essential for slowing the progression of PAD to critical limb ischemia and reducing the risk of myocardial infarction and death. Circulation to the legs will decrease if the legs are elevated. Patients with PAD are taught to exercise to the point of feeling pain, rest, and then resume walking. Support hose are not used for patients with PAD.
The nurse is assessing a patient in the emergency department with a history of an abdominal aortic aneurysm with severe back pain and absent pedal pulses. Which of the following actions should the nurse take first?
- A. Obtain the blood pressure.
- B. Ask the patient about tobacco use.
- C. Draw blood for ordered laboratory testing.
- D. Assess for the presence of an abdominal bruit.
Correct Answer: A
Rationale: Since the patient appears to be experiencing aortic dissection, the nurse's first action should be to determine the hemodynamic status by assessing blood pressure. The other actions also may be done, but they will not provide information that will determine what interventions are needed immediately for this patient.
The nurse is providing teaching to a patient with a venous ulcer on the right lower leg. Which of the following patient statements indicates a need for further teaching?
- A. I will put on my support stockings before I get out of bed in the morning.
- B. I will take an antibiotic for a few days to prevent infection of the ulcer.
- C. I will eat more meat and other high-protein foods.
- D. I will apply a compression dressing every evening before I go to bed.
Correct Answer: B
Rationale: Compression of the leg is essential to healing of venous ulcers in patients with chronic venous insufficiency. High dietary intake of protein, rather than carbohydrates, is needed. Prophylactic antibiotics are not routinely used for venous ulcers. Moist environment dressings are used to hasten wound healing. Applying a compression dressing only in the evening is insufficient; it should be worn consistently to promote healing.