An Asian American man and his Caucasian wife are both taking warfarin (Coumadin) daily because of atrial fibrillation. The husband asks why he is prescribed a much smaller than average dose of the drug to keep his international normalized ratio (INR) at 2.0 and his wife takes the average dose even though he is taller and heavier than she is. What is the nurse’s best response? Select one: a. Many Asian Americans do not break down warfarin as fast as Caucasians, so the drug is more effective at lower dosages b. “Caucasians have higher levels of the enzyme that breaks down warfarin, requiring higher dosages for the same effect on INR.” c. “Body size is not important for warfarin but gender differences are because testosterone improves its action.” d. You are probably anemic, which would reduce your ability to form blood clots, so your doses can be lower.”

asians need lower dosages than caucasians and caucasians need dosages lower than african americans

Explanation: per the AHA journal

americans began to notice growing differences between the northern and southern sections of the country. there were more people living in cities in the north, which made it more urban. more people lived on farms in the south, which made it more rural. while many people were farmers in the northern states, there were now other ways to make a living, such as working in mechanical cotton gins factories manufacturing cloth, tools and other goods. people in the north supported high tariffs on goods imported from europe because the extra cost encouraged people to “buy american” instead. in the southern states, planters did not like tariffs because they sold most of their production to europe and bought their tools from there as well. southerners believed the protective tariff was something that only northern factory owners keep their profits high. so the southern politicians came up with an idea. they would opt out. they would simply ignore the protective tariff. it was ‘null and void’ in south carolina. the state would not collect the taxes on goods imported into south carolina, no matter what the president said they had to do. this decision led to the nullification crisis.