A nurse is monitoring a client who is receiving a unit of packed red blood cells (RBCs) following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload?

Choice A reason: Warfarin PO is not a suitable medication for DVT prophylaxis in the immediate postoperative period, as it has a slow onset of action and requires frequent monitoring of the INR (international normalized ratio). Warfarin may be used for long-term anticoagulation, but it is not effective for preventing the formation of new clots.

Choice B reason: Enoxaparin subcutaneous is a suitable medication for DVT prophylaxis in the immediate postoperative period, as it has a rapid onset of action and does not require frequent monitoring of the coagulation status. Enoxaparin is a low-molecular-weight heparin that inhibits the formation of thrombin and prevents the growth of existing clots.

Choice C reason: Aspirin PO is not a suitable medication for DVT prophylaxis in the immediate postoperative period, as it has a weak anticoagulant effect and may increase the risk of bleeding. Aspirin is an antiplatelet agent that inhibits the aggregation of platelets and prevents the formation of arterial clots, but it is not effective for preventing venous clots.

Choice D reason: Heparin infusion is not a suitable medication for DVT prophylaxis in the immediate postoperative period, as it requires continuous intravenous administration and frequent monitoring of the aPTT (activated partial thromboplastin time). Heparin is an unfractionated heparin that inhibits the formation of thrombin and prevents the growth of existing clots, but it has a narrow therapeutic window and a high risk of bleeding.

Choice A reason: Infection is the correct condition that the client is at increased risk for. Agranulocytosis is a severe decrease in the number of granulocytes, which are a type of white blood cell that fight infection. Propylthiouracil is an antithyroid drug that can cause agranulocytosis as a rare but serious side effect. The client with agranulocytosis is more susceptible to bacterial and fungal infections, and may present with fever, sore throat, mouth ulcers, and skin lesions.

Choice B reason: Excessive bleeding is not the correct condition that the client is at increased risk for. Agranulocytosis does not affect the platelets, which are the blood cells that help with clotting. Propylthiouracil does not cause bleeding disorders, although it may interact with anticoagulants and increase their effect.

Choice C reason: Hyperglycemia is not the correct condition that the client is at increased risk for. Agranulocytosis does not affect the insulin, which is the hormone that regulates blood glucose levels. Propylthiouracil does not cause hyperglycemia, although it may interfere with the metabolism of oral hypoglycemic agents and decrease their effect.

Choice D reason: Ecchymosis is not the correct condition that the client is at increased risk for. Ecchymosis is a bruise caused by bleeding under the skin. Agranulocytosis does not cause ecchymosis, as it does not affect the blood vessels or the platelets. Propylthiouracil does not cause ecchymosis, although it may increase the risk of skin rash and pruritus.