A nurse is caring for a group of clients. Click to specify whether anticoagulation therapy is anticipated or not anticipated for each client.
A client with low platelet count
A client with history of hemophilia A
A client with an indwelling epidural catheter
A client diagnosed with pulmonary embolism
A post operative client on bed rest
The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}
• A client diagnosed with pulmonary embolism: Anticoagulation is standard therapy to prevent clot propagation and reduce the risk of further thromboembolic events. Medications such as heparin or low-molecular-weight heparin are commonly initiated to manage pulmonary embolism. Early anticoagulation improves patient outcomes and reduces mortality.
• A post-operative client on bed rest: Prolonged immobility increases the risk for venous thromboembolism. Anticoagulation may be anticipated as a preventive measure, especially in clients with additional risk factors such as advanced age or comorbidities. Prophylactic therapy reduces the incidence of deep vein thrombosis and pulmonary embolism.
• A client with low platelet count: Anticoagulation increases the risk of bleeding in clients with thrombocytopenia. Low platelet count is a contraindication because these clients are prone to spontaneous bleeding and hemorrhage. Careful evaluation of bleeding risk is required before considering therapy.
• A client with history of hemophilia A: Hemophilia A is a congenital clotting disorder characterized by factor VIII deficiency. Anticoagulation in these clients would exacerbate bleeding tendencies and is contraindicated. Management focuses on preventing and treating bleeding episodes, not clot prevention.
• A client with an indwelling epidural catheter: Anticoagulation is contraindicated in clients with epidural catheters due to the risk of epidural hematoma formation. Hematomas can compress the spinal cord, causing permanent neurological damage. Anticoagulants are withheld until the catheter is safely removed and bleeding risk is minimized.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Clarify the order with the healthcare provider: The order for digoxin 25 mg IV is dangerously high and far exceeds the usual therapeutic dose (typically micrograms, not milligrams). The nurse must verify the order before administration to prevent life-threatening toxicity.
B. Listen to the apical pulse for one minute: While assessing the apical pulse is essential before administering digoxin to check for bradycardia, verifying the unusually high dose takes priority to ensure client safety.
C. Obtain a current blood pressure reading: Monitoring blood pressure is important because digoxin can affect cardiac output, but confirming the safety of the ordered dose comes before vital sign assessment in this scenario.
D. Ensure the client's IV site is patent: Ensuring IV patency is necessary for safe medication administration, but it is secondary to clarifying an unsafe order to prevent immediate harm to the client.
Correct Answer is D
Explanation
A. Hyperkalemia: Milrinone primarily affects cardiac contractility and vascular tone and does not typically cause hyperkalemia. Elevated potassium levels would more likely be related to other medications, renal dysfunction, or underlying conditions rather than milrinone therapy.
B. Hypertension: Milrinone is a phosphodiesterase-3 inhibitor that causes vasodilation, which generally lowers blood pressure rather than increases it. Hypertension is not a common adverse effect of long-term milrinone use.
C. Calf pain: Calf pain could indicate deep vein thrombosis or musculoskeletal issues, but it is not a recognized adverse effect of milrinone. While it should be assessed, it is unlikely related to the drug.
D. Heart palpitations: Milrinone can cause arrhythmias, including palpitations, ventricular tachycardia, or atrial fibrillation, especially with long-term use. The presence of palpitations is a significant adverse effect and warrants immediate assessment and possible adjustment of therapy.
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