A patient admitted to the medical-surgical unit is being treated ...

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A patient admitted to the medical-surgical unit is being treated with warfarin (Coumadin) for prevention of thrombus. The patient develops hyperuricemia, and allopurinol (Zyloprim) is prescribed.
 
  The nurse should anticipate which change in the drug regimen?
  a. Reduction of the warfarin dose
  b. Increase in the warfarin dose
  c. Discontinuation of the allopurinol
  d. Increase in the allopurinol dose

Question 2

A nurse prepares to administer IV colchicine. Which precaution is correct?
 
  a. The medication should be administered in an IV line with D5 normal saline.
  b. The medication should be diluted with a bacteriostatic solution.
  c. The medication should be administered over 1 minute.
  d. The nurse should verify that the IV line is in the vein and patent.

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Answer to Question 1

ANS: A
The nurse should anticipate a reduction in the warfarin dose, because allopurinol may enhance its effects.
Increasing the dose of warfarin would further increase the risk for bleeding while the patient is receiving allopurinol.
Because the patient needs treatment for hyperuricemia, discontinuing the allopurinol is not feasible; therefore, other options need to be considered.
Increasing the dose of allopurinol would further potentiate the effect of warfarin.

Answer to Question 2

ANS: D
The nurse should confirm that the IV catheter is in the vein and patent. Extravasation of the drug can cause local necrosis, with sloughing of the skin and subcutaneous tissue.
The medication should be diluted and administered with 20 mL of sterile sodium chloride.
The medication should be diluted with sterile sodium chloride; no specific solution is identified here.
The medication should be administered over 5 minutes or longer.

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