A client is taking warfarin and asks the nurse if taking St. John's wort is acceptable.
What response by the nurse is best?

Choice A rationale

Bathing a child with infantile eczema using products containing fragrance can be irritating to the already compromised skin barrier. Fragrances are common allergens and can trigger or worsen the inflammatory response in atopic dermatitis. It is essential to use fragrance-free, hypoallergenic products to minimize irritation and prevent exacerbations.

Choice B rationale

Using oatmeal and baking soda as bath additives can be soothing for the irritated skin of a child with infantile eczema. Colloidal oatmeal contains avenanthramides which have anti-inflammatory and antioxidant properties, while baking soda can help to relieve itching. These additives can help to calm the skin and reduce the urge to scratch.

Choice C rationale

Adding bath oil to bath water after the child has soaked for a period of time is a beneficial practice. Soaking in water allows the skin to rehydrate. Adding the oil at the end of the bath helps to seal in the moisture, forming a protective barrier and preventing transepidermal water loss, which is a key issue in eczema.

Choice D rationale

Lanolin is a fatty substance derived from sheep wool. While it can be a good moisturizer, it is also a common allergen. Applying lanolin-based lotions to a child with eczema can potentially trigger an allergic reaction or worsen the skin condition. It is safer to use hypoallergenic, non-irritating moisturizers.

Choice E rationale

Bathing a child several times a day can strip the skin of its natural oils, which can worsen the dryness and irritation associated with infantile eczema. The skin barrier is already compromised, and frequent bathing can exacerbate this problem. It is generally recommended to limit bathing to once a day or less to maintain skin integrity. .

Choice A rationale

Regular assessment for bleeding is critical because heparin inhibits the coagulation cascade by enhancing antithrombin III, which inactivates thrombin and factor Xa. This increases the risk of hemorrhage, so the nurse must monitor for signs like petechiae, ecchymosis, hematuria, or GI bleeding to prevent serious complications. Platelets should be maintained above 100,000.

Choice B rationale

The activated partial thromboplastin time (aPTT) measures the time it takes for a fibrin clot to form via the intrinsic and common pathways of the coagulation cascade. Heparin therapy is monitored by the aPTT, with a therapeutic range typically 1.5 to 2.5 times the client’s baseline or control value, usually 45-75 seconds.

Choice C rationale

Stopping an IV heparin infusion for an aPTT above baseline is not always the correct action, as the therapeutic range is purposefully elevated. The aPTT should be 1.5 to 2.5 times the control value. An aPTT above this therapeutic range warrants holding the dose or adjusting the rate according to established hospital protocols and provider orders.

Choice D rationale

Using an IV pump is essential for heparin infusion to ensure precise and consistent administration. Heparin is a high-alert medication with a narrow therapeutic index. An IV pump prevents boluses and ensures the client receives the exact prescribed dose over time, minimizing the risk of subtherapeutic levels or overdose.

Choice E rationale

Daily weighing is crucial for monitoring fluid balance and detecting fluid shifts, which can indicate internal bleeding, a significant risk with heparin. Using the same scale at the same time each day, with the client wearing similar clothing, ensures accurate and comparable measurements, providing a reliable trend of the client’s weight.