A 78-year-old female patient was recently diagnosed with atrial ...

[JMatthes]

A 78-year-old female patient was recently diagnosed with atrial fibrillation and started on Coumadin (warfarin) for stroke prophylaxis. A nurse provides extensive education on warfarin including the need for routine blood testing.
 
  The woman states the following to a nurse: I understand all that you have taught me, but I do not know what a good number for the INR test is. The nurse bases her response on the knowledge that the recommended INR is:
  a. 1.0-2.0.
  b. 2.0-3.0.
  c. 3.0-4.0.
  d. 4.0-5.0.

Question 2

A 69-year-old patient in the geriatric clinic has an annual physical examination and a complete blood count and serum electrolytes are drawn.
 
  While the physical examination was uneventful, the laboratory results show an elevated blood urea nitrogen (BUN). The nurse will then:
  a. ask that the test be rerun since the client showed no physical signs of renal failure.
  b. review the client's medication list since BUN can be affected by many specific medications.
  c. instruct the client on collecting a 24-hour urine specimen for a more detailed analy-sis.
  d. assure the client that an elevated BUN is normal in older adults.

[akpaschal]

Answer to Question 1

ANS: B
Recommended INR for an individual with atrial fibrillation for stroke prevention in individuals over age 75 is 2.0-3.0.

Answer to Question 2

ANS: B
BUN can be elevated as a result of certain medication therapies and so the nurse should assess for this possibility. An elevated BUN is not diagnostic of renal failure alone and will not neces-sarily be reflected in physical symptoms. A 24-hour urine sample will not generally be done to determine BUN levels. An elevated BUN is not expected as a normal part of aging. Renal func-tioning decreases substantially with aging, but in most cases the body is able to compensate ade-quately with only slight increases in laboratory findings.

[JMatthes]

Thank you

[akpaschal]

Happy to help you