Warfarin

You're educating a patient's family member about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the family member require you to re-educate them about how this medication works? Select all that apply: A. "This medication will help dissolve the blood clot." B. "This medication will prevent another blood clot from forming." C. "This medication will help prevent the blood clot from becoming bigger in size." D. "This medication starts working immediately after the first dose."

A. "This medication will help dissolve the blood clot." D. "This medication starts working immediately after the first dose." The answers are A and D. Warfarin (Coumadin) does NOT dissolve blood clots. It prevents blood clots from forming, and if one is present, it will help prevent it from becoming bigger. If the blood clot becomes bigger it may break off and travel in blood circulation. This can lead to a pulmonary embolism, heart attack, or stroke. Warfarin (Coumadin) does NOT start working immediately. It takes about 3-5 days of scheduled doses to start achieving a therapeutic INR level. It is very common that a patient will be on Heparin while taking Warfarin until INR levels are therapeutic.

A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication? A. 2-3 B. 1-3 C. 4-8 D. 0.5-2.5

A. 2-3 The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation....(ex: up to 4.5)

Which patients below are NOT candidates for Warfarin (Coumadin)? Select all that apply: A. A 45-year-old male patient with alcoholism and an active GI ulcer. B. A 55-year-old female with a heart valve replacement. C. A 36-year-old female with a deep vein thrombosis. D. A 52-year-old male who needs a liver transplant.

A. A 45-year-old male patient with alcoholism and an active GI ulcer. D. A 52-year-old male who needs a liver transplant. The answers are: A and D...Option A is NOT a candidate because active ulcer disease places the patient at risk for bleeding while taking Warfarin (Coumadin). In addition, patients should NOT drink alcohol while taking Warfarin (Coumadin) because it majorly affects how the drug works. Option D is NOT a candidate because of the liver disease. Warfarin affects the liver's clotting factors. Option B and D would benefit because both are at risk for a blood clots (especially option B). While Option C already has a blood clot, Warfarin (Coumadin) would help prevent it from becoming larger and new clots from forming.

Your patient was started on Warfarin (Coumadin) a week ago for the treatment of a DVT. Which findings below would indicate an adverse reaction to this medication? Select all that apply: A. Patient reports a severe and sudden headache B. Melena C. Chvostek's Sign D. Hematuria E. Coffee ground emesis F. Bleeding gums

A. Patient reports a severe and sudden headache B. Melena D. Hematuria E. Coffee ground emesis F. Bleeding gums The answers are A, B, D, E, and F. An adverse reaction would be associated with bleeding. Patients who take Warfarin should be monitored for signs and symptoms that bleeding is occurring internally. Example would be: sudden/severe headache (represents intracranial bleed), melena (dark, tarry stools...represent blood), hematuria (urine reddish or pink), coffee ground emesis (bleeding in the stomach), or bleeding gums....along with tachycardia, hypotension, nosebleeds, or bruising for no reason. Chvostek's Sign is associated with a low calcium level (hypocalcemia).

You're providing discharge teaching to a patient who will be going home on Warfarin (Coumadin). Which statements by the patient demonstrate they understood the educational material provided? Select all that apply: A. "I will switch and use a hard bristle toothbrush." B. "When I shave I will be sure to use an electric razor." C. "I will be sure that I eat a diet rich in spinach, kale, and broccoli." D. "I will avoid drinking any alcoholic beverages."

B. "When I shave I will be sure to use an electric razor." D. "I will avoid drinking any alcoholic beverages." The answers are B and D. A patient should use a SOFT bristle toothbrush rather than a hard bristle to prevent damaging the gums (this can lead to bleeding). Also, the patient should maintain a normal diet, but avoid consuming excessive amounts of green leafy vegetables (like spinach, kale, broccoli, lettuce etc.) because this can alter how the medication works. The patient should AVOID alcoholic beverages and use electric razors.

What is considered a normal INR level in a person who is NOT taking Warfarin (Coumadin)? A. 10-12 seconds B. 0.75-1.25 C. 2-3 D. 5-7

B. 0.75-1.25 The answer is B. This is considered a normal INR level in someone who is NOT taking Warfarin (Coumadin).

A patient is taking Warfarin (Coumadin). What order received from the physician requires that you ask for an order clarification? A. Check PT/INR daily B. Administer Prednisone IM daily C. Ambulate three times per day D. Draw CBC in the morning

B. Administer Prednisone IM daily The answer is B. IM (intramuscular) injections should be AVOIDED in patients taking Warfarin (Coumadin) due to the bleeding risk. Other routes should be ordered.

TRUE OR FALSE: If a patient's INR level falls too low, there is a risk of clot formation and the Warfarin (Coumadin) dose needs to be decreased. A. True B. False

B. False The answer is False. If a patient's INR level falls too low, there is a risk of clot formation and the Warfarin (Coumadin) dose needs to be INCREASED (not decreased).

A patient is scheduled to take a dose of Warfarin (Coumadin) at 1800. The patient's INR level is 6. As the nurse you will? A. Administer the dose as scheduled B. Hold the dose and notify the physician C. Double the dose D. Hold today's dose but administer tomorrow's dose as scheduled.

B. Hold the dose and notify the physician The answer is B. A therapeutic INR level should be 2-3 (it may be up to 4.5 if the patient is at a HIGH risk for blood clot formation). A level of 6 is HIGH and places the patient at risk for bleeding. The nurse should hold the dose and notify the physician.

A patient, who is taking Warfarin (Coumadin), asks what he should do if he misses a dose. Your response would be: A. Double the dose the next day and notify the physician. B. Take the dose when remembered, if on the same day. However, if not remembered on the same day but the next day, skip the missed dose and take the next dose at the regular scheduled time. C. Hold all doses and call the doctor. D. Split the dose the next day.

B. Take the dose when remembered, if on the same day. However, if not remembered on the same day but the next day, skip the missed dose and take the next dose at the regular scheduled time. The answer is B. If a dose is missed the patient should take the dose when remembered IF on the SAME day. However, if not remembered on the SAME day but the next day, the patient should skip the missed dose and take the next scheduled dose at its regular scheduled time.

Warfarin (Coumadin) affects the formation of certain clotting factors. Select below ALL the clotting factors this medication affects: A. I B. V C. II D. VII E. XI F. X G. IX

C. II D. VII F. X G. IX The answers are: C, D, F, and G. Warfarin (Coumadin) affects FOUR clotting factors that require vitamin K to form. These clotting factors are: 2, 7, 9, and 10 (II, VII, IX, X)

Warfarin (Coumadin) is an anticoagulant. What family of anticoagulant medications does this drug belong to? A. Direct thrombin inhibitors B. Indirect thrombin inhibitors C. Vitamin K antagonists D. Factor Xa inhibitors

C. Vitamin K antagonists The answer is C. Warfarin (Coumadin) is an anticoagulant that belongs to the Vitamin K antagonists.

Which statement below BEST describes how Warfarin (Coumadin) works as an anticoagulant? A. "It inhibits the formation of thrombin and fibrin in the clotting process." B. "It increases the production of Factor Xa, which blocks thrombin and decreases the clotting process." C. "It binds to antithrombin and reverses the clotting process." D. "It stops the coagulation process by blocking the formation of clotting factors in the liver that require Vitamin K to form."

D. "It stops the coagulation process by blocking the formation of clotting factors in the liver that require Vitamin K to form." The answer is D. Warfarin (Coumadin) stops the coagulation process by blocking the formation of clotting factors in the liver that require Vitamin K to form. This is why this drug is part of the Vitamin K antagonist family.

What is the antidote for Warfarin (Coumadin)? A. Flumazenil B. Narcan C. Protamine Sulfate D. Vitamin K

D. Vitamin K The answer is D. Vitamin K is the antidote for Warfarin (Coumadin).