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A 68-Year-Old Man Is Brought to the Emergency Department with 2

question 163

Multiple Choice

A 68-year-old man is brought to the emergency department with 2 days of bright red blood per rectum. He complains of feeling dizzy and extremely fatigued. Six months ago, he had a diverticular bleed that required hospitalization. The patient has moderate chronic obstructive pulmonary disease (COPD) and uses his inhalers regularly. Three weeks ago, he was hospitalized for a COPD exacerbation and was also found to have a right femoral and popliteal vein thrombosis; he was discharged on warfarin. His mobility is significantly impaired by right hip osteoarthritis and back pain. Blood pressure is 80/60 mm Hg and pulse is 115/min and regular. Mucous membranes are pale. The abdomen is soft and nontender. There is swelling of the right ankle and calf. Laboratory results are as follows: $A 68-year-old man is brought to the emergency department with 2 days of bright red blood per rectum. He complains of feeling dizzy and extremely fatigued. Six months ago, he had a diverticular bleed that required hospitalization. The patient has moderate chronic obstructive pulmonary disease (COPD) and uses his inhalers regularly. Three weeks ago, he was hospitalized for a COPD exacerbation and was also found to have a right femoral and popliteal vein thrombosis; he was discharged on warfarin. His mobility is significantly impaired by right hip osteoarthritis and back pain. Blood pressure is 80/60 mm Hg and pulse is 115/min and regular. Mucous membranes are pale. The abdomen is soft and nontender. There is swelling of the right ankle and calf. Laboratory results are as follows: Warfarin is stopped. He is volume resuscitated and given a blood transfusion and fresh frozen plasma. Lower endoscopy reveals a diverticular bleed. Which of the following is the best management for this patient's deep venous thrombosis? A) Initiate low-molecular-weight heparin B) Initiate rivaroxaban C) Initiate unfractionated heparin D) Initiate warfarin with goal INR of 1-1.5 E) Place a retrievable inferior vena cava filter F) Place compression stockings G) Symptomatic treatment only$ Warfarin is stopped. He is volume resuscitated and given a blood transfusion and fresh frozen plasma. Lower endoscopy reveals a diverticular bleed. Which of the following is the best management for this patient's deep venous thrombosis?

Definitions:

Fixed-Ratio

A schedule of reinforcement where a response is reinforced only after a specified number of responses have occurred.

Variable-Ratio

A reinforcement schedule where a response is reinforced after an unpredictable number of responses, promoting high and steady response rates.

Contingency

A future event or circumstance that is possible but cannot be predicted with certainty, often used in psychology to describe the relationship between behavior and its consequences.