A patient is being treated with warfarin Coumadin to prevent ...

[Metfan725]

A patient is being treated with warfarin Coumadin to prevent thrombus. The patient develops hyperuricemia, and the provider orders allopurinol Zyloprim. The nurse will contact the provider to discuss ____ the ____ dose.
 
  a. increasing; allopurinol
  b. increasing; warfarin
  c. reducing; allopurinol
  d. reducing; warfarin

Question 2

A nurse is caring for a child who has hemophilia. While reviewing this child's immunization records, the nurse notes that the child needs the tetanus and reduced diphtheria toxoids and acel-lular pertussis (Tdap) vaccine and the hepatitis A vaccine
 
  . The nurse should notify the provider and obtain an order to give: a. both vaccines intramuscularly.
  b. both vaccines subcutaneously.
  c. the hepatitis A vaccine only subcuta-neously.
  d. the Tdap vaccine only intramuscularly.

[C.mcnichol98]

Answer to Question 1

D
Allopurinol can inhibit hepatic drug-metabolizing enzymes and thus delay the inactivation of other drugs. This is a particular concern in patients taking warfarin; therefore, the warfarin dose should be reduced when allopurinol is also used. It is not correct to increase the allopurinol dose, increase the warfarin dose, or reduce the allopurinol dose.

Answer to Question 2

A
To minimize the risk of hepatitis, all patients with hemophilia should be fully vaccinated, and all newly diagnosed patients should receive both the hepatitis A and hepatitis B vaccines to minim-ize the risk of hepatitis from infusions. Clinicians should inject vaccines intramuscularly, taking precautions to prevent excessive bleeding, because subcutaneous administration does not guar-antee efficacy. There is no reason to withhold any vaccine in children with hemophilia.

[Metfan725]

Thank you!

[C.mcnichol98]

Always glad to help...