A client is hospitalized with a second episode of pulmonary ...

[FButt]

A client is hospitalized with a second episode of pulmonary embolism (PE). Recent genetic testing reveals the client has an alteration in the gene CYP2C19. What action by the nurse is best?
 
  a. Instruct the client to eliminate all vitamin K from the diet.
  b. Prepare preoperative teaching for an inferior vena cava (IVC) filter.
  c. Refer the client to a chronic illness support group.
  d. Teach the client to use a soft-bristled toothbrush.

Question 2

A client is on intravenous heparin to treat a pulmonary embolism. The client's most recent partial thromboplastin time (PTT) was 25 seconds. What order should the nurse anticipate?
 
  a. Decrease the heparin rate.
  b. Increase the heparin rate.
  c. No change to the heparin rate.
  d. Stop heparin; start warfarin (Coumadin).

[Tabitha_2016]

Answer to Question 1

ANS: B
Often clients are discharged from the hospital on warfarin (Coumadin) after a PE. However, clients with a variation in the CYP2C19 gene do not metabolize warfarin well and have higher blood levels and more side effects. This client is a poor candidate for warfarin therapy, and the prescriber will most likely order an IVC filter device to be implanted. The nurse should prepare to do preoperative teaching on this procedure. It would be impossible to eliminate all vitamin K from the diet. A chronic illness support group may be needed, but this is not the best intervention as it is not as specific to the client as the IVC filter. A soft-bristled toothbrush is a safety measure for clients on anticoagulation therapy.

Answer to Question 2

ANS: B
For clients on heparin, a PTT of 1.5 to 2.5 times the normal value is needed to demonstrate the heparin is working. A normal PTT is 25 to 35 seconds, so this client's PTT value is too low. The heparin rate needs to be increased. Warfarin is not indicated in this situation.