Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
8. A client has been receiving warfarin (Coumadin) and heparin for 2 days following a total knee arthroplasty. Laboratory results show that INR is 1.2, Hct is 34%. A nurse should:
. Hold the Coumadin, continue the heparin.
. Hold the heparin, continue the Coumadin.
. Hold both drugs and call the physician.
. Continue both drugs as ordered.
Test-Taking Tip
Look at the verbs: three "hold" and one "continue." Choose the option that is different in this case.
Content Area: Adult Health, Musculoskeletal; Integrated Process: Nursing Process, Implementation; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
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Answer 1 is incorrect because the goal is a therapeutic international normalized ratio (INR). Coumadin will be needed to maintain an INR of about 2. Answer 2 is incorrect because the quick-acting drug, heparin, acts as an anticoagulant "bridge" until the slower onset of Coumadin achieves therapeutic levels. Answer 3 is incorrect because the client needs anticoagulation, being at high risk for clots. There is no evidence that a contraindication for these drugs exists, such as bleeding. Answer 4 is correct because clients having knee surgery are at very high risk for thrombus formation and need anticoagulation. Coumadin is convenient because it can be taken for several days of therapy before achieving therapeutic results (an INR level of 2). Until achieved, the quicker acting drug, heparin, is also used.