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Questions and Answers
Warfarin is a medication that requires monitoring by laboratory testing due to its narrow therapeutic window.
True
The therapeutic PT value for a patient on warfarin is approximately 2 times control.
False
When starting warfarin therapy, daily evaluation of INR is necessary until a stable daily dose is achieved.
True
If a prescriber changes the warfarin dose, less frequent INR measurements are necessary.
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INR monitoring is not required once a stable dose of warfarin is achieved.
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The therapeutic value for adequate anticoagulation with heparin is 45 to 70 seconds.
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During heparin therapy, aPTT should be maintained at 1 to 1.5 times the control or baseline value.
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It is necessary to monitor aPTT when low-dose standard heparin is given subcutaneously for thromboembolism prophylaxis.
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The nurse should hold the dose if the INR is above 3.0.
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Assessing for therapeutic effects includes looking for signs like reduced edema and pain with DVT.
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The nurse should administer vitamin C as an antidote for warfarin if the INR level is above 5.0.
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The nurse should assess for signs of HIT during warfarin therapy.
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The nurse assesses for signs of bleeding, including excessive bruising and blood in urine or stool, when monitoring for adverse effects of warfarin.
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The nurse should ensure that PT and INR values are within the therapeutic range.
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Prothrombin complex concentrate (PCC) is used for urgent warfarin reversal with minor bleeding.
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Why should rivaroxaban not be used in individuals with a creatinine clearance of less than 15 mL/min?
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What is a reason for rivaroxaban being considered inappropriate in older adults?
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In which patient population should rivaroxaban be avoided according to the text?
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Why is it common practice to use rivaroxaban for home care following knee or hip surgery?
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What is a key reason for avoiding rivaroxaban use in patients with moderate to severe hepatic impairment?
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What is an important consideration when using dabigatran etexilate in older adults?
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Why is dabigatran etexilate use not recommended in patients receiving hemodialysis?
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Which of the following is a common adverse effect associated with dabigatran etexilate administration?
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What is a contraindication for using dabigatran etexilate?
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Why does the risk of bleeding with dabigatran etexilate increase with age?
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What is the recommended therapeutic value for aPTT (activated partial thromboplastin time) when a patient is on heparin therapy?
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What is a major concern when administering heparin to premature infants?
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What is the primary reason for using weight as the basis for determining heparin dosage in children?
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What is the recommended therapeutic INR range for a patient on warfarin therapy?
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In what scenario should a nurse consider monitoring a patient's INR more frequently?
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Study Notes
Warfarin Management
- Warfarin has a narrow therapeutic window requiring careful laboratory monitoring.
- Therapeutic PT value for warfarin patients is about double the control value.
- Daily INR evaluations are necessary when initiating warfarin therapy until a stable dose is reached.
- After any dose adjustments, INR checks can be done less frequently.
- INR monitoring is not required once a stable dose of warfarin is achieved.
Heparin Therapy
- Effective anticoagulation with heparin is achieved with therapeutic values of 45 to 70 seconds.
- During heparin therapy, aPTT should be maintained at 1 to 1.5 times the baseline control value.
- aPTT monitoring is essential when administering low-dose standard heparin subcutaneously for thromboembolism prophylaxis.
Nursing Guidelines and Monitoring
- Hold warfarin dose if INR exceeds 3.0 to reduce bleeding risk.
- Therapeutic effects include reduced swelling and pain in DVT; monitor for these signs.
- Administer vitamin K as an antidote if INR levels are above 5.0.
- Assess for signs of Heparin-Induced Thrombocytopenia (HIT) while on warfarin.
- Monitor for bleeding symptoms, such as excessive bruising or blood in urine/stool.
- Ensure PT and INR values remain within therapeutic range.
- Prothrombin complex concentrate (PCC) is utilized for urgent warfarin reversal in cases of minor bleeding.
Rivaroxaban Considerations
- Avoid rivaroxaban in patients with creatinine clearance < 15 mL/min due to excretion issues.
- Inappropriate for older adults due to increased bleeding risk and potential for renal impairment.
- Rivaroxaban is commonly administered for home care after knee or hip surgery due to its manageable dosing regimen.
- Contraindicated in patients with moderate to severe hepatic impairment to prevent adverse effects.
Dabigatran Etexilate Insights
- In older adults, monitor closely for renal function as it may decline with age, affecting drug clearance.
- Dabigatran use is not recommended in hemodialysis patients due to inadequate removal of the drug.
- A common adverse effect associated with dabigatran is bleeding complications.
- Risk of bleeding with dabigatran increases with patient age due to declining physiological factors.
Additional Considerations
- Recommended aPTT therapeutic value during heparin therapy is 1.5 to 2.5 times the control value.
- Major concern for administering heparin to premature infants includes the risk of bleeding.
- Weight-based dosing is crucial in children to ensure appropriate therapeutic levels of heparin.
- Recommended therapeutic INR range for warfarin therapy is typically between 2.0 and 3.0.
- Consider more frequent INR monitoring if there are significant changes in diet, medication, or health status of the patient.
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Description
Test your knowledge on monitoring warfarin therapy, including the need for daily evaluation of INR and the interaction with foods high in vitamin K. Learn about the narrow therapeutic window of vitamin K antagonists like warfarin and the importance of laboratory testing.
