A 38-year-old female client was diagnosed with a right lower extremity deep vein thrombosis (DVT) after surgery 2 days ago. This morning the nurse reviews the client's electronic health record to complete a shift assessment. Data from the health record include a prescription from the primary health care provider for warfarin 5 mg orally every day, and the following laboratory results:

• Hemoglobin: 17 g/dL
• Hematocrit: 44.9%
• WBC count: 5500/mm³
• Platelets: 160,000/mm³
• aPTT: 40 sec
• PT: 12 sec
• INR: 0.9
• BUN: 16 mg/dL
• Creatinine: 0.6 mg/dL

The nurse assesses the client for which signs and symptoms of a DVT?

Choice A reason:
Monitoring for signs of dehydration is essential because Mr. Carter's symptoms (fatigue, nausea, and jaundice) and laboratory results indicate acute hepatitis A, which can cause significant fluid loss due to nausea and reduced oral intake. Assessing hydration status ensures timely intervention to prevent complications such as hypovolemia. Additionally, high bilirubin levels and elevated liver enzymes suggest hepatic dysfunction, which may impair the body's ability to maintain fluid balance.
Choice B reason:
Educating Mr. Carter on proper hand hygiene is crucial to prevent the transmission of hepatitis A, which is highly contagious and spreads via the fecal-oral route. Since Mr. Carter has recently traveled to an area with poor sanitation, providing education on hygiene practices is an immediate priority to protect others. Proper handwashing with soap and clean water significantly reduces the risk of spreading the infection.
Choice C reason:
Encouraging a high-protein diet to repair liver damage is not appropriate during the acute phase of hepatitis A. Protein metabolism requires significant liver function, which is impaired in Mr. Carter’s case due to elevated ALT and AST levels. Emphasizing adequate hydration and balanced nutrition (without overloading the liver with protein) is more suitable. Dietary recommendations for hepatitis A focus on small, frequent meals and avoiding foods that burden liver function.
Choice D reason:
Administering intravenous antibiotics is unnecessary because hepatitis A is a viral infection, not bacterial. Antibiotics do not address viral infections and would not benefit Mr. Carter’s recovery. Supportive care, including hydration, rest, and symptom management, is the mainstay of treatment for viral hepatitis A.
Choice E reason:
Advising rest and limiting physical activity is vital to support Mr. Carter’s recovery. Fatigue and jaundice indicate that his liver is under significant strain, and rest helps reduce metabolic demands on the liver, allowing it to heal more effectively. Light activity may be reintroduced as symptoms improve, but physical exertion should be avoided during the acute phase.
Choice F reason:
Educating the patient about the need for lifelong hepatitis A vaccination is unnecessary because recovery from hepatitis A usually provides lifelong immunity. Vaccination is more relevant for individuals who are at risk and have not been exposed to the virus. Mr. Carter’s current care plan should focus on managing the acute phase of the disease and preventing transmission to others.

Choice A reason: An elevated blood pressure of 148/84 mm Hg is significant and could be related to prednisone use, as corticosteroids can increase blood pressure. However, this finding alone is not as urgent as the abrupt cessation of prednisone, which can lead to adrenal insufficiency and other serious complications.
Choice B reason: Not taking prescribed vitamin D is important, especially in long-term corticosteroid therapy, as vitamin D helps mitigate the risk of bone density loss. However, this issue is not as immediately critical as abruptly stopping prednisone.
Choice C reason: Stopping prednisone abruptly after taking it for 3 weeks is critical information that must be reported to the healthcare provider immediately. Prednisone is a corticosteroid that suppresses the adrenal glands' ability to produce natural steroids. Abrupt discontinuation can lead to adrenal insufficiency, which can be life-threatening. Symptoms of adrenal insufficiency include severe fatigue, weakness, body aches, low blood pressure, and potential shock. Gradual tapering is required to allow the adrenal glands to recover and resume natural steroid production.
Choice D reason: Bilateral 2+ pitting ankle edema is a notable finding and may indicate fluid retention, which can be a side effect of prednisone. While it is important and requires monitoring, it does not carry the same immediate risk as the abrupt cessation of the medication.