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.

Answer and Explanation

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.

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Correct Answer is A

Explanation

A) This choice is correct. Performing calf-stretching exercises in the aisle can help improve blood circulation in the legs during a long flight and reduce the risk of stasis and clot formation.

B) This choice is incorrect because using a heating pad on the legs during a flight may not be feasible or safe. It is not a recommended preventive measure for DVT.

C) This choice is incorrect because wearing compression stockings during the flight is a recommended preventive measure for DVT. Compression stockings help improve blood flow and reduce the risk of clot formation during prolonged immobility.

D) This choice is incorrect because taking prescribed anticoagulant medication before boarding a flight is not a recommended preventive measure for all clients. The decision to take anticoagulant medication before a flight should be based on the client's individual risk factors and medical history.

A. Encouraging active range of motion exercises. B. Administering low-dose aspirin daily. C. Applying a heating pad to the affected leg. D. Providing a soft mattress for the client's bed.

Correct Answer is A

Explanation

A) This choice is correct. Encouraging active range of motion exercises helps prevent deep vein thrombosis (DVT) by promoting blood flow and reducing stasis in the veins. Moving the legs and ankles regularly helps prevent clot formation in immobilized clients.

B) This choice is incorrect because low-dose aspirin is not specifically indicated for preventing DVT. While aspirin may have some antiplatelet effects, it is not the primary preventive measure for DVT in high-risk clients.

C) This choice is incorrect because applying a heating pad to the affected leg is not a preventive measure for DVT. Heat application is not recommended for DVT prevention and could cause burns or injury.

D) This choice is incorrect because providing a soft mattress for the client's bed does not directly prevent DVT. The focus should be on encouraging movement and mobility to prevent DVT in clients at risk.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with a history of deep vein thrombosis (DVT) is scheduled for a long-haul flight. What should the nurse recommend to the client as a preventive measure during the flight?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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