A nurse is reviewing the medical record of a client who is to undergo open heart surgery. Which of the following findings should the nurse report to the provider as a contraindication to receiving heparin?

Thalassemia

Rheumatoid arthritis

Thrombocytopenia

COPD

Answer and Explanation

The Correct Answer is C

A. Thalassemia: A genetic blood disorder affecting hemoglobin production. While patients with severe anemia may have an increased bleeding risk, thalassemia itself is not a contraindication to heparin. Caution is needed if the patient has splenomegaly or significant anemia.

B. Rheumatoid arthritis: An autoimmune condition that can increase bleeding risk due to chronic inflammation and medication use, such as NSAIDs or corticosteroids. However, heparin is not contraindicated unless there is an associated bleeding disorder or severe thrombocytopenia.

C. Thrombocytopenia: A condition characterized by a low platelet count, significantly increasing the risk of bleeding. Heparin use can worsen this condition, especially in cases of heparin-induced thrombocytopenia (HIT), which can lead to both bleeding and thrombosis.

D. COPD: A chronic lung disease that does not directly contraindicate heparin therapy. While COPD patients may be at risk for deep vein thrombosis due to immobility, heparin remains a standard prophylactic treatment unless there are other bleeding risks.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. "Your provider would not prescribe this treatment if it weren't necessary.": While the provider recommends treatment based on medical necessity, the decision to continue or discontinue chemotherapy ultimately lies with the client. This response does not acknowledge the client’s autonomy.

B. "Chemotherapy is your best chance for survival.": This response focuses on treatment efficacy rather than addressing the client's emotional and personal concerns. It may also create pressure rather than supporting the client’s decision-making process.

C. "It is your decision whether to continue chemotherapy.": This response is appropriate as it acknowledges the client’s autonomy and right to make healthcare decisions. It validates the client’s concerns while offering support without imposing an opinion.

D. "Why don't you want to continue treatment?": Asking "why" may make the client feel defensive or pressured to justify their decision. A more open-ended approach, such as "Can you tell me more about your concerns?" would be a better way to explore the client’s feelings.

A. Prone with the legs adducted B. Side-lying on the affected side C. Supine with the head slightly elevated D. High-Fowler's with a pillow under the knees

Correct Answer is C

Explanation

A. Prone with the legs adducted: Prone positioning is not recommended after hip arthroplasty as it places pressure on the surgical site and does not support proper hip alignment. Adduction of the legs increases the risk of hip dislocation.

B. Side-lying on the affected side: Lying on the operative side can cause pain and increase pressure on the hip joint, which may compromise healing. It is generally recommended to avoid side-lying positions unless specifically advised by the provider.

C. Supine with the head slightly elevated: Keeping the client in a supine position with the head elevated and the legs abducted helps maintain proper hip alignment and reduces the risk of dislocation. A wedge or abduction pillow is often used to prevent the legs from crossing.

D. High-Fowler's with a pillow under the knees: A high-Fowler's position increases hip flexion beyond the recommended 90-degree limit, which can lead to dislocation. Placing a pillow under the knees can also increase the risk of venous stasis and deep vein thrombosis.

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A nurse is reviewing the medical record of a client who is to undergo open heart surgery. Which of the following findings should the nurse report to the provider as a contraindication to receiving heparin?

Nursing Test Bank

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