NR 547 Differential Diagnosis in
Psychiatric-Mental Health
Across the Lifespan Practicum
NR 547 Week 7 CEA Pre-Clinical Diagnostic Exam Remediation
1. The one main reason direct oral anticoagulants (DOACs) can NOT be used include which
of the following?
A patient with active mitral valve disease
Atrial fibrillation lasting over 48 hours
Post-surgical thrombotic risk prophylaxis
Known deep vein thrombosis (DVT)
Answer
Direct Oral Anticoagulants (DOACs)
Usage
Direct Oral Anticoagulants (DOACs) are commonly used for various indications, but
there are specific situations where their use is contraindicated or requires caution.
Main Reason DOACs Cannot Be Used
Among the options provided, the main reason DOACs cannot be used is:
• A patient with active mitral valve disease
Explanation of Each Option
1. A patient with active mitral valve disease
• DOACs are not recommended for patients with mechanical prosthetic heart
valves or significant mitral valve disease. 1 This is because these conditions
require precise anticoagulation management, which is better achieved with
, warfarin due to its ability to be monitored and adjusted. DOACs have not
been validated for use in these patients and may lead to suboptimal
anticoagulation and increased risk of thromboembolic events.
2. Atrial fibrillation lasting over 48 hours
• While DOACs are used for atrial fibrillation, the concern with atrial fibrillation
lasting over 48 hours is the potential for thrombus formation in the left atrial
appendage. 2 However, DOACs are often used in this context, especially if
cardioversion is planned, as they provide effective anticoagulation.
3. Post-surgical thrombotic risk prophylaxis
• DOACs can be used for post-surgical thrombotic risk prophylaxis, depending
on the type of surgery and the patient's risk factors. 1 They are effective in
preventing venous thromboembolism in certain surgical settings.
4. Known deep vein thrombosis (DVT)
• DOACs are indicated for the treatment of DVT, making this option incorrect
for the question. 1 They are effective and often preferred due to their ease of
use and lack of need for routine monitoring.
Conclusion
In summary, the most critical reason for not using DOACs in the context provided is
related to a patient with active mitral valve disease due to the need for precise
anticoagulation management that DOACs cannot provide. Always consult clinical
guidelines and a healthcare professional for specific patient management.
2. Examples of antibiotics with zero order kinetics include which of the following?
Gentamicin (Garamycin)
Amoxicillin (Moxatag)
Oxacillin (Bactocil)
Sulfamethoxazole/Trimethoprim (Bactrim DS)
Answer
Antibiotics with Zero Order Kinetics
Zero order kinetics refers to a situation where the rate of drug elimination is
constant, regardless of the drug concentration. This is typically seen in certain
antibiotics. Among the options provided, the following antibiotic is known to exhibit
zero order kinetics:
Psychiatric-Mental Health
Across the Lifespan Practicum
NR 547 Week 7 CEA Pre-Clinical Diagnostic Exam Remediation
1. The one main reason direct oral anticoagulants (DOACs) can NOT be used include which
of the following?
A patient with active mitral valve disease
Atrial fibrillation lasting over 48 hours
Post-surgical thrombotic risk prophylaxis
Known deep vein thrombosis (DVT)
Answer
Direct Oral Anticoagulants (DOACs)
Usage
Direct Oral Anticoagulants (DOACs) are commonly used for various indications, but
there are specific situations where their use is contraindicated or requires caution.
Main Reason DOACs Cannot Be Used
Among the options provided, the main reason DOACs cannot be used is:
• A patient with active mitral valve disease
Explanation of Each Option
1. A patient with active mitral valve disease
• DOACs are not recommended for patients with mechanical prosthetic heart
valves or significant mitral valve disease. 1 This is because these conditions
require precise anticoagulation management, which is better achieved with
, warfarin due to its ability to be monitored and adjusted. DOACs have not
been validated for use in these patients and may lead to suboptimal
anticoagulation and increased risk of thromboembolic events.
2. Atrial fibrillation lasting over 48 hours
• While DOACs are used for atrial fibrillation, the concern with atrial fibrillation
lasting over 48 hours is the potential for thrombus formation in the left atrial
appendage. 2 However, DOACs are often used in this context, especially if
cardioversion is planned, as they provide effective anticoagulation.
3. Post-surgical thrombotic risk prophylaxis
• DOACs can be used for post-surgical thrombotic risk prophylaxis, depending
on the type of surgery and the patient's risk factors. 1 They are effective in
preventing venous thromboembolism in certain surgical settings.
4. Known deep vein thrombosis (DVT)
• DOACs are indicated for the treatment of DVT, making this option incorrect
for the question. 1 They are effective and often preferred due to their ease of
use and lack of need for routine monitoring.
Conclusion
In summary, the most critical reason for not using DOACs in the context provided is
related to a patient with active mitral valve disease due to the need for precise
anticoagulation management that DOACs cannot provide. Always consult clinical
guidelines and a healthcare professional for specific patient management.
2. Examples of antibiotics with zero order kinetics include which of the following?
Gentamicin (Garamycin)
Amoxicillin (Moxatag)
Oxacillin (Bactocil)
Sulfamethoxazole/Trimethoprim (Bactrim DS)
Answer
Antibiotics with Zero Order Kinetics
Zero order kinetics refers to a situation where the rate of drug elimination is
constant, regardless of the drug concentration. This is typically seen in certain
antibiotics. Among the options provided, the following antibiotic is known to exhibit
zero order kinetics:
