A client with deep vein thrombosis (DVT) is receiving a continuous heparin IV infusion. The client now has tarry, black diarrhea and reports abdominal pain. Which actions should the nurse implement? Select all that apply.
Review last partial thromboplastin time (PTT) results.
Auscultate bowel sounds in all quadrants.
Monitor stools for presence of blood.
Prepare to administer warfarin.
Assess characteristics of pain.
Correct Answer : A,B,C,E
Choice A reason: Reviewing the last PTT results is important to ensure that the heparin therapy is within the therapeutic range and to assess for potential over-anticoagulation.
Choice B reason: Auscultating bowel sounds in all quadrants helps determine if there is any bowel obstruction or ileus, which can be associated with abdominal pain.
Choice C reason: Monitoring stools for the presence of blood is essential to identify gastrointestinal bleeding, which can present as tarry, black stools.
Choice D reason: Preparing to administer warfarin is not appropriate in the acute management of potential gastrointestinal bleeding and should be done based on the healthcare provider's instructions.
Choice E reason: Assessing the characteristics of pain is important to better understand the cause of abdominal pain and guide further management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: A listing of African-American women in the community may help identify the target audience but is not as crucial as engaging the community leaders.
Choice B reason: Morbidity data for breast cancer in women of all races provides background information but does not directly address the specific needs of African-American women.
Choice C reason: Technical assistance to produce a video is useful but secondary to involving the community in the planning process.
Choice D reason: Participation of community leaders is vital as they can provide insights into cultural and social factors that influence health behaviors, ensuring the program is culturally relevant and effective.
Correct Answer is B
Explanation
Choice A reason: Assessing skin turgor is important for hydration status but not specifically related to prasugrel.
Choice B reason: Observing the color of urine is important as it can indicate hematuria (blood in the urine), a potential adverse effect of prasugrel, which is an antiplatelet medication that increases the risk of bleeding.
Choice C reason: Checking for pedal edema is important for overall cardiovascular assessment but not specifically related to monitoring adverse effects of prasugrel.
Choice D reason: Measuring body temperature is important for detecting infection but not specifically related to prasugrel's adverse effects.
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.
