A client with deep vein thrombosis (DVT) is prescribed anticoagulant therapy. What is the nurse's priority action in monitoring the client's response to the medication?
Assessing for changes in blood pressure.
Monitoring the client's prothrombin time (PT) and international normalized ratio (INR).
Checking the client's blood glucose levels.
Evaluating the client's respiratory rate and pattern.
The Correct Answer is B
A) This choice is incorrect because while monitoring blood pressure is essential, it is not the priority action for clients on anticoagulant therapy. The primary concern is assessing the client's response to the medication and their risk of bleeding.
B) This choice is correct. Monitoring the client's prothrombin time (PT) and international normalized ratio (INR) is crucial in assessing the effectiveness of anticoagulant therapy. The PT and INR measure how long it takes the blood to clot and help determine the appropriate dosage of anticoagulants to achieve the desired therapeutic effect.
C) This choice is incorrect because checking the client's blood glucose levels is not directly related to monitoring the response to anticoagulant therapy. Blood glucose monitoring is essential for clients with diabetes but not a priority in this context.
D) This choice is incorrect because evaluating the client's respiratory rate and pattern is not the priority action for monitoring the response to anticoagulant therapy. Respiratory assessment is vital in detecting potential complications like a pulmonary embolism but does not directly assess the client's anticoagulation status.
Questions
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) This choice is incorrect because compression stockings do not dissolve existing blood clots. Their primary purpose is to prevent new blood clots from forming by aiding blood flow and preventing stasis in the veins.
B) This choice is incorrect because while compression stockings may help reduce swelling in the affected leg by supporting venous return, their primary function is to prevent DVT and not specifically address swelling.
C) This choice is incorrect because compression stockings primarily target venous circulation in the legs and do not directly improve blood circulation throughout the entire body.
D) This choice is correct. Compression stockings exert pressure on the legs, assisting in venous return and preventing blood from pooling and clot formation. They are used as a preventive measure for individuals at risk of DVT or those diagnosed with DVT to reduce the risk of complications and recurrence.
Correct Answer is B
Explanation
A) This choice is incorrect because while isometric exercises can promote blood flow, the recommended preventive measure for DVT is wearing graduated compression stockings. Exercises alone may not be sufficient to prevent clot formation.
B) This choice is correct. Graduated compression stockings apply pressure to the lower extremities, improving blood flow and reducing the risk of stasis and clot formation. They are commonly used as a preventive measure for clients at risk of DVT, particularly after surgery or during prolonged immobility.
C) This choice is incorrect because limiting fluid intake is not a preventive measure for DVT and may not be safe or appropriate for all clients. Adequate hydration is essential to maintain blood volume and circulation.
D) This choice is incorrect because elevating the legs while resting is a recommended measure to improve blood flow and reduce edema, which can be beneficial. However, wearing graduated compression stockings is a more specific preventive measure for DVT.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.