Question: A client was started on oral anticoagulant therapy while hospitalized. The client is now being discharged to home and is intermittently confused. The nurse determines that the client has the best support system for successful anticoagulant therapy monitoring if the client:
1. Has a home health aide coming to the house for 9 weeks
2. Was going to stay with a daughter in the daughter’s home indefinitely
3. Was going to have blood work drawn in the home by a local laboratory
4. Has a good friend living next door who would take the client to the doctor
Answer: 2
Rationale: The client taking anticoagulant therapy should be informed about the medication, its purpose, and the necessity of taking the proper dose at the specified times. If the client is unwilling or unable to comply with the medication regimen, the continuance of the regimen should be questioned. Clients may need support systems in place to enhance compliance
with therapy. Option 1 facilitates reminding the client to take the medication, option 3 facilitates blood work only, and option 4 facilitates medical care. Option 2 provides a direct support system.
Priority Nursing Tip: Anticoagulants are administered when there is evidence of or likelihood of clot formation. Such situations include myocardial infarction, unstable angina, atrial fibrillation, deep vein thrombosis, pulmonary embolism, and the presence of mechanical heart valves.
Test-Taking Strategy: Use the process of elimination, and note the subject, the best support system. Note that option 2 is the only option that indicates direct support for the client. Review the concepts surrounding support systems for the client if you had difficulty with this question.
Level of Cognitive Ability: Evaluating
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process/Evaluation
Content Area: Adult Health/Cardiovascular
References: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 819). St. Louis: Saunders.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed., pp. 889–890).
St. Louis: Mosby.
This week’s NCLEX exam practice question came from:
Silvestri: Saunders Q&A Review for the NCLEX-RN Examination, 5th Edition, Test 4, Page 387, Question 823
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