A nurse is caring for a client who experienced a lacerated spleen and has been on bedrest for several days. The nurse auscultates decreased breath sounds in the lower lobes of both lungs. The nurse should realize that this finding is most likely an indication of which of the following conditions?

A. While heparin and warfarin both work as anticoagulants, IV heparin is not typically used to increase the effects of warfarin or decrease the length of hospital stay. Heparin is often administered initially to rapidly achieve therapeutic anticoagulation while waiting for warfarin to reach its full therapeutic effect, but it is not intended to directly enhance the action of warfarin.
B. This statement is accurate and provides a clear explanation to the client. Warfarin, an oral anticoagulant, takes several days to achieve a therapeutic level in the bloodstream and to exert its anticoagulant effect. During this time, IV heparin is continued to prevent clot formation until the therapeutic level of warfarin is reached.
C. While both heparin and warfarin work to prevent blood clots, they do not directly dissolve existing clots. Rather, they prevent the formation of new clots and the growth of existing ones. This explanation does not fully address the client's question regarding why both medications are necessary.
D. Discontinuing IV heparin prematurely without reaching a therapeutic level of warfarin could increase the risk of thrombus formation or embolization. Therefore, discontinuing IV heparin should be done under the guidance of the provider based on the client's INR levels and the target therapeutic range for warfarin.

Here's how we can find the desired flow rate:

1. Total volume to infuse (in minutes):
   • We need to convert the infusion time from hours to minutes.
   • Time (minutes) = Time (hours) x 60 minutes/hour
   • Time (minutes) = 2 hours x 60 minutes/hour
   • Time (minutes) = 120 minutes
2. Total volume to infuse (in mL):
   • Given volume = 250 mL
3. Drop factor (gtts/mL):
   • Given drop factor = 15 gtts/mL
4. Flow rate (gtts/minute):
   • Flow rate = Total volume (mL) / Time (minutes) x Drop factor (gtts/mL)
   • Flow rate = 250 mL / 120 minutes x 15 gtts/mL

To simplify the calculation, we can divide all values by 5 (as long as we perform the division on both sides of the equation, the answer won't change):

• Flow rate = (250 mL / 5) / (120 minutes / 5) x (15 gtts/mL / 5)
• Flow rate = 50 mL / 24 minutes x 3 gtts/mL
• Flow rate = 2.0833... gtts/minute (round to nearest whole number)

1. Rounded flow rate (gtts/minute):
   • Flow rate = 2 gtts/minute

Therefore, the nurse should adjust the flow rate to deliver approximately 2 gtts/minute.