HELP! please help me understand this NCLEX question!

Nurses General Nursing

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I am currently studying for the NCLEX and using the Saunders comprehensive review, i came across this question.......

A client with atrial fibrillation who is receiving maintenance therapy with warfarin sodium (Coumadin) has a prothrombin time (PT) of 30 seconds. The nurse anticipates that which will be prescribed?

ANSWER CHOICES

Adding a dose of heparin

Increasing the next dose of warfarin sodium

Withholding the next dose of warfarin sodium

Administering the next dose of warfarin sodium

The correct answer is 3, Withholding the next dose of warfarin sodium, and I DO NOT understand the rationale. (T[COLOR=#000000]he normal PT is 9.6 to 11.8 seconds for the adult male and 9.5 to 11.3 seconds for the adult female. The goal of oral anticoagulation with warfarin sodium therapy is to achieve a PT at 1.5 to 2 times the laboratory control value. A PT of 30 seconds places the client at risk for bleeding, so the nurse should anticipate that the client would not receive further doses at this time. If the level is too high, the antidote (vitamin K) may be prescribed. The remaining options would make the client even more prone to bleeding.[/COLOR])

I thought the answer would be administering warfarin (blood thinner)

[COLOR=#000000]SOO..if the PT is HIGH (30 SECONDS) Doesn't that mean it takes a LONG TIME for the blood to clot, meaning that the patient should be receiving a blood THINNER ?

someone please help me understand this PT/INR/blood thin/clot process???

THANKS![/COLOR]

they provided you the rationale below. A normal value is 9.5 / 11.3 sec. They want a value 1.5/2 times that number. So the longest it should take is 11.3 * 2 seconds. Or 22.6 seconds. This person is taking 30 seconds to clot. Which is too long of a time and puts them at risk of bleeding. Would you give them more medication? Or withhold a dose?

Specializes in Family Medicine, Tele/Cardiac, Camp.

Blood thinning agents (warfarin for example) will make it so your blood takes longer to clot. This is why we give it to people with stuff like A-fib - to prevent clotting complications such as pulmonary emobolus, DVT, or stroke. Thick blood clots easily whereas thin blood will take longer to clot. An increase in PT and INR indicate thinner blood. If someone already has a high PT/INR, then we think about problems that could arise from having blood that is *too* thin such as serious bleeding in the GI tract or brain, for example; and we then think about how we can go about addressing this - whether it's decreasing the dose, withholding a dose, or adding vitamin K - to make blood just a little bit thicker but not too thick it can cause serious clots to form.

Hope this helps.

Specializes in Pedi.
SOO..if the PT is HIGH (30 SECONDS) Doesn't that mean it takes a LONG TIME for the blood to clot, meaning that the patient should be receiving a blood THINNER ?

someone please help me understand this PT/INR/blood thin/clot process???

THANKS![/COLOR][/font]

Yes it means the blood is taking a long time to clot but no, it does not mean that the patient "should be receiving a blood thinner". If the blood is already taking a long time to clot, why would you want to administer a dose of medication that's going to make it take even longer? The point of Coumadin is to prevent clots from forming, it extends the clotting time. This patient is supratherapeutic. If a patient not on Coumadin had a PT of 30 seconds, that would be a problem that you most certainly would not treat with an anticoagulant.

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