Author Question: A client has been diagnosed with a deep vein thrombosis and is to be discharged on warfarin ... (Read 34 times)

debasdf · **on:** Jun 25, 2018

A client has been diagnosed with a deep vein thrombosis and is to be discharged on warfarin (Coumadin). The client is adamant about refusing the drug because it's dangerous. What action by the nurse is best?

a. Assess the reason behind the client's fear.
b. Remind the client about laboratory monitoring.
c. Tell the client drugs are safer today than before.
d. Warn the client about consequences of noncompliance.

Question 2

A client with a history of heart failure and hypertension is in the clinic for a follow-up visit. The client is on lisinopril (Prinivil) and warfarin (Coumadin). The client reports new-onset cough. What action by the nurse is most appropriate?

a. Assess the client's lung sounds and oxygenation.
b. Instruct the client on another antihypertensive.
c. Obtain a set of vital signs and document them.
d. Remind the client that cough is a side effect of Prinivil.

courtney_bruh · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: A
The first step is to assess the reason behind the client's fear, which may be related to the experience of someone the client knows who took warfarin. If the nurse cannot address the specific rationale, teaching will likely be unsuccessful. Laboratory monitoring once every few weeks may not make the client perceive the drug to be safe. General statements like drugs are safer today do not address the root cause of the problem. Warning the client about possible consequences of not taking the drug is not therapeutic and is likely to lead to an adversarial relationship.

Answer to Question 2

ANS: A
This client could be having an exacerbation of heart failure or be experiencing a side effect of lisinopril (and other angiotensin-converting enzyme inhibitors). The nurse should assess the client's lung sounds and other signs of oxygenation first. The client may or may not need to switch antihypertensive medications. Vital signs and documentation are important, but the nurse should assess the respiratory system first. If the cough turns out to be a side effect, reminding the client is appropriate, but then more action needs to be taken.