Walkthrough: Pharmacological and Parenteral Therapies Q7 – NCLEX-RN®

00:01 The nurse is caring for a client who is prescribed Warfarin.

00:05 Which client statement indicates an understanding of the instructions? Okay, so I have a client who's on Warfarin.

00:13 And I'm looking for something that is correct or safe.

00:17 So because there indicates understanding would be a correct or safe statement about being prescribed Warfarin.

00:25 Now, pause for a minute and see if you can remember what Warfarin is.

00:29 Good. Think about the things we used to treat it for.

00:32 And then what are some of the particular risks with this medication? Because we know safety is a main concept on the NCLEX.

00:40 So knowing any bad things that might help with Warfarin, that's what we're going to be watching for.

00:46 Ready to look at the answer choices? Here they come.

00:57 Okay, we've got four options.

00:59 So again, I'm looking for something that is correct or safe for a patient on Warfarin.

01:06 So is it correct or safe? With the patient says, "When I get lab work, my target INR is 3.0 to 5.0?" Well, that's a number, and you have to make a call.

01:18 Is that high, low, or normal? Number two.

01:23 "I will stay on this medication for at least one to two weeks." Is that correct or safe for Warfarin? Number three.

01:31 I'll stop taking it after the pain and swelling subsides." Is that right or safe for a patient on Warfarin? Number four.

01:40 "I won't take aspirin or NSAIDs while I'm taking this drug." Is that correct or safe for Warfarin? Okay, now it's up to you.

01:49 Work through each one of these four options.

01:52 Eliminate them one at a time.

01:54 But remember, say while you're eliminating them.

01:57 So pause the video.

01:59 And then after you've selected your answer, do it on your own first, that's the way you get the most out of the series.

02:06 Then I'll come back and walk you through the whole question.

02:10 Welcome back. Are you ready to break this down? Okay. Now remember, you should have your answer selected first, because that's how you learn how you can take tests more effectively.

02:22 So if you haven't done that, pause the video.

02:25 If you have, let's get going.

02:27 Okay, number one.

02:28 When I get lab work, my target INR is 3.0 to 5.0.

02:34 Is that correct, or safe for someone on Warfarin? Umm...

02:39 No. That is not correct or safe.

02:42 Now, INR that means if I have this lab work done at one hospital, and someone else has a lab work done at another hospital, it's going these values are normalized that you can compare them to each other.

02:56 You know, we always tell you, "Hey, remember, lab work is a little different from lab to lab.

03:00 Well, that's what INR is.

03:02 They found a kind of a standardized process.

03:05 So we know that we want their INR to be higher than normal.

03:10 But we do not want it to be five.

03:12 At the most to likely want it, two to three, but not higher than three.

03:18 Okay, so that's why that is out.

03:20 If we had this patient get an INR 5, they're at risk for internal bleeding.

03:25 If they fell and bumped their head, they're really going to have a problem, right? That could be a bleed in their brain.

03:31 So no, no to number one.

03:33 Let's look at number two.

03:34 I will stay on this medication for at least one to two weeks.

03:38 Whoo... that'd be great if that's how it worked.

03:41 But that's not how this works.

03:43 Because remember, Warfarin is that drug that they have to change their diet, because they can't eat foods that are high in Vitamin K, because that's what will stop the action of Warfarin.

03:53 So you have to stay on this drug for a long time.

03:57 Usually, it gonna be like six months to a year, depending on the risk factors or the variables.

04:02 So no, you're not going to be on this for one to two weeks.

04:05 It's going to be a period of months, as decided by your healthcare provider.

04:10 But keep in mind, I don't push a lot of diet questions.

04:14 But it would be really smart for you to know what are the vitamin K rich foods? Because that could come up in a dietary question later on.

04:22 So, if you're not familiar with those, and it's a lot of green leafy healthy things, write yourself a note in your notebook and make sure you go back and review that so it won't catch you on the NCLEX.

04:33 Number three, and number four are the ones we have left.

04:37 So is it right or say for Warfarin, if the patient says, "I'll stop taking it after the pain and swelling subsides." Hmm. Okay, if number two is wrong, and we know the rationale because they're on it for six months to a year, the number three has to be wrong.

04:56 But I'm not just going to assume it's number four.

04:58 I'm going to read through it and make sure I'm clear.

05:01 I won't take aspirin or NSAIDs while I am taking this drug.

05:06 Is that correct or safe for someone on Warfarin? Ding, ding, ding, ding ding. That's our winner.

05:12 Right? When someone is on Warfarin, we're making sure they don't clot as well, right? We're trying to make sure that for the six to 12 months, they've recovered from that episode that they had that caused the patient to be put on Warfarin.

05:25 So you don't want to take additional NSAIDs.

05:29 Aspirin is an example of an NSAID but so as naproxen sodium or ibuprofen.

05:34 So those drugs could really make things worse.

05:38 That led to increased risk for bleeding and we don't want that.

05:41 That's why number four is correct.

05:44 You won't take aspirin or NSAIDs while I'm taking this drug is the safest statement, and it indicates patient understanding.

05:52 Okay, let's go to the next one.