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 C
Explanation
A) This choice is incorrect because fasting is not necessary before a venous Doppler ultrasound. The client can eat and drink normally before the test.
B) This choice is incorrect because the client should continue to take prescribed medications as usual unless otherwise instructed by the healthcare provider. Medications that thin the blood, such as anticoagulants, may not be stopped before the test.
C) This choice is correct. The client should wear loose-fitting clothing that can be easily removed to allow access to the affected area during the ultrasound. This facilitates the ultrasound technician's ability to perform the test accurately.
D) This choice is incorrect because contrast dye is not typically used in a venous Doppler ultrasound. Contrast venography may involve the use of contrast dye, but not Doppler ultrasound.
Questions
Correct Answer is A
Explanation
A) This choice is correct. The D-dimer blood test is a rapid and sensitive screening test that can help rule out DVT in low-risk individuals. A negative D-dimer result can be useful in excluding DVT, avoiding unnecessary imaging or invasive tests.
B) This choice is incorrect because contrast venography is not a rapid test and involves invasive procedures. It is not used as a first-line screening test due to its complexity and potential risks.
C) This choice is incorrect because magnetic resonance imaging (MRI) may provide valuable information, but it is not the first choice for rapid rule-out of DVT. MRI may be employed in specific cases when initial screening tests are inconclusive.
D) This choice is incorrect because the Wells score assessment is not a diagnostic test but a scoring system to estimate the likelihood of DVT. It does not provide rapid results to rule out DVT directly.
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