A nurse is preparing to discharge a patient newly prescribed ...

[mydiamond]

A nurse is preparing to discharge a patient newly prescribed warfarin (Coumadin). While assessing the patient's knowledge of the drug, what would indicate that the patient needs further instruction concerning drug therapy?
 
  A) I love to eat homegrown tomatoes in the summer.
  B) I take aspirin for my arthritis.
  C) I walk 2 miles a day.
  D) I drink a glass of wine about once a week.

Question 2

The mother brings her 18-month-old toddler to the pediatrician because the child has a fever and has been tugging on his or her left ear.
 
  Examination of the tympanic membrane confirms an ear infection and the toddler also has a cold with nasal congestion, rhinorrhea, and a cough. The provider tells the mother to apply heat and gives her a prescription for an otic anesthetic to make the ear more comfortable until the infection resolves. The mother is not happy and says she wants a prescription for an antibiotic. What important teaching points will the nurse include in the teaching plan? (Select all that apply.) A) Ear infections that accompany viral respiratory infections do not respond to antibiotics.
  B) Habitual use of antibiotics for viral infections contribute to development of resistant strains.
  C) Adverse effects from antibiotics in children can cause diarrhea and dehydration.
  D) Antibiotics will only be prescribed if a culture indicates the presence of bacteria in the ear.
  E) The pediatrician knows more than the mother and she should trust what she is being told.

[ju]

Answer to Question 1

B
Feedback:
Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will instruct the patient to stop taking aspirin. Walking, eating tomatoes, and drinking an occasional glass of wine should not interfere with the therapeutic effects of warfarin.

Answer to Question 2

A, B, C
Feedback:
When the child has a viral respiratory infection, the organism involved in ear infections is usually viral as well. As a result, antibiotics will have no effect on the infection that will resolve independently and only comfort care is indicated. Habitual use of antibiotics for viral infections contributes to the development of resistant strains of bacteria and the adverse effects can make the child more uncomfortable causing diarrhea and dehydration. Cultures of ear fluid are almost never done because it would be an invasive procedure to remove fluid from the middle ear. It is never right for the nurse to patronize the mother, who has every right to advocate for her child, and it is more important she understand why the antibiotic is not being prescribed than telling her the pediatrician knows more.

[mydiamond]

TYSM

[recede]

Excellent