NRNP 6566 / NRNP6566 Advanced Care of Adults in
Acute Settings I Week 5 Knowledge Check | Questions
and Verified Answers | Latest
NRNP 6566 / NRNP6566 Advanced Care of Adults in
Acute Settings I Week 5 Knowledge Check | Questions
and Verified Answers | Latest
A 64-year-old man diagnosed with a pulmonary embolism is currently on warfarin. His INR
readings have been very inconsistent, and the decision is made to change his medication to
Rivaroxaban (Xarelto). What dose should be initiated and how would you discontinue the
warfarin?
Correct
Answer: Warfarin should be discontinued. Once the INR reaches 2.0 or below, Xarelto
15 mg bid x 3 weeks would be initiated. After 3 weeks, the dose is changed to
20 mg daily.
• Question 2
A 66-year-old man was evaluated for shortness of breath for the last three months. Diagnostic
work up confirmed a pulmonary embolism. He is alert and oriented. Vital signs are stable. He
is ambulatory. He has a stable home environment and good support from his wife. He is on
day 2 of treatment with Lovenox 90 mg every 12 hours. The patient wants to go home.
Would you discharge him? How would you manage his medications?
Correct
NRNP 6566 / NRNP6566 Advanced Care of Adults
in Acute Settings I Week 5 Knowledge Check |
Questions and Verified Answers | Latest
, NRNP 6566 / NRNP6566 Advanced Care of Adults in
Acute Settings I Week 5 Knowledge Check | Questions
and Verified Answers | Latest
Answer: The 2019 Chest guideline supports outpatient treatment for stable, reliable
patients with stable home environments. The patient should continue the Lovenox
for a minimum of 5 days. He will need a minimum of 3 months treatment with an
oral agent. If warfarin is selected, the patient should start on it now with the hope
that his INR is therapeutic by day 5. NOTE- he should not stop the Lovenox until
his INR is in the therapeutic range. If a direct thrombin inhibitor or factor Xa
inhibitor is selected, he should start on day 5 taking the first dose 2 hours before
the Lovenox dose is due.
• Question 3
A 26-year-old male was injured in a motorcycle crash 3 days ago. He sustained an acute
subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury and resulting
paralysis. He has a warm swollen right lower leg. Duplex ultrasound of the right lower leg is
positive. What is the best treatment for this patient?
Correct
Answer: This patient is high risk for development of deep vein thrombosis and potential
pulmonary embolism. The acetabular fracture is a further complicating injury. An
inferior vena cava filter would be indicated in this patient to prevent a pulmonary
embolism. According to the 2019 Chest guidelines, IVC filters are not first line
treatment but this patient is very high risk for VTE, and the subdural hematoma
would probably make anticoagulants contraindicated.
• Question 4
NRNP 6566 / NRNP6566 Advanced Care of Adults
in Acute Settings I Week 5 Knowledge Check |
Questions and Verified Answers | Latest
Acute Settings I Week 5 Knowledge Check | Questions
and Verified Answers | Latest
NRNP 6566 / NRNP6566 Advanced Care of Adults in
Acute Settings I Week 5 Knowledge Check | Questions
and Verified Answers | Latest
A 64-year-old man diagnosed with a pulmonary embolism is currently on warfarin. His INR
readings have been very inconsistent, and the decision is made to change his medication to
Rivaroxaban (Xarelto). What dose should be initiated and how would you discontinue the
warfarin?
Correct
Answer: Warfarin should be discontinued. Once the INR reaches 2.0 or below, Xarelto
15 mg bid x 3 weeks would be initiated. After 3 weeks, the dose is changed to
20 mg daily.
• Question 2
A 66-year-old man was evaluated for shortness of breath for the last three months. Diagnostic
work up confirmed a pulmonary embolism. He is alert and oriented. Vital signs are stable. He
is ambulatory. He has a stable home environment and good support from his wife. He is on
day 2 of treatment with Lovenox 90 mg every 12 hours. The patient wants to go home.
Would you discharge him? How would you manage his medications?
Correct
NRNP 6566 / NRNP6566 Advanced Care of Adults
in Acute Settings I Week 5 Knowledge Check |
Questions and Verified Answers | Latest
, NRNP 6566 / NRNP6566 Advanced Care of Adults in
Acute Settings I Week 5 Knowledge Check | Questions
and Verified Answers | Latest
Answer: The 2019 Chest guideline supports outpatient treatment for stable, reliable
patients with stable home environments. The patient should continue the Lovenox
for a minimum of 5 days. He will need a minimum of 3 months treatment with an
oral agent. If warfarin is selected, the patient should start on it now with the hope
that his INR is therapeutic by day 5. NOTE- he should not stop the Lovenox until
his INR is in the therapeutic range. If a direct thrombin inhibitor or factor Xa
inhibitor is selected, he should start on day 5 taking the first dose 2 hours before
the Lovenox dose is due.
• Question 3
A 26-year-old male was injured in a motorcycle crash 3 days ago. He sustained an acute
subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury and resulting
paralysis. He has a warm swollen right lower leg. Duplex ultrasound of the right lower leg is
positive. What is the best treatment for this patient?
Correct
Answer: This patient is high risk for development of deep vein thrombosis and potential
pulmonary embolism. The acetabular fracture is a further complicating injury. An
inferior vena cava filter would be indicated in this patient to prevent a pulmonary
embolism. According to the 2019 Chest guidelines, IVC filters are not first line
treatment but this patient is very high risk for VTE, and the subdural hematoma
would probably make anticoagulants contraindicated.
• Question 4
NRNP 6566 / NRNP6566 Advanced Care of Adults
in Acute Settings I Week 5 Knowledge Check |
Questions and Verified Answers | Latest
