Supportive and Preventive Medicine

Answer: D

Warfarin can be initiated (Answer C is incorrect) once

the Plt has recovered to at least 150,000/mm3 and after at

least 5 days of therapy with an alternative anticoagulant

(Answer D is correct). Because this patient’s Plts have

not reached 150,000/mm3 and only 3 days of argatroban

have been completed, warfarin therapy should not be

initiated at this time (Answers A and B are incorrect).

Argatroban should be continued, and warfarin may be

considered after 5 days of therapy and once the Plt has

recovered (Answer B is incorrect).

Answer: D

Up to 50% of seriously ill hospitalized patients have

moderate or severe pain. Opioids are the treatment main-

stay for patients with pain and dyspnea at the end of life.

Assessing pain in the ICU can be particularly challeng-

ing because many patients have impaired cognition and

communication. Vital signs alone should not be used for

pain assessment (Answer A is incorrect). Evidence sug-

gests that pain can be improved with correct dosing and

titration (Answers B and C are incorrect) without caus-

ing respiratory depression or hastening death (Answer

D is correct).