Mr. Carter, a 35-year-old male, presents to the clinic with complaints of fatigue, nausea, intermittent abdominal pain, and jaundice. He reports that he recently returned from a week-long trip to a rural area in Southeast Asia, where he ate local food and drank untreated water. He denies any history of alcohol use or intravenous drug use. Laboratory results include:

Test	Result	Normal Range
ALT (Alanine Aminotransferase)	1.200 U/L	7-56 U/L
AST (Aspartate Aminotransferase)	1.000 U/L	10-40 U/L
Total Bilirubin	5.5 mg/dL	0.1-1.2 mg/dL
Hepatitis A IgM	Positive	Negative

Medications: None reported.

Social History: Works as a teacher, lives alone.

Identify the priority nursing interventions for Mr. Carter. (Select all that apply)

Choice A reason: Consulting with the speech-language pathologist for a swallowing evaluation is essential because the client has occasional dysphagia. Swallowing difficulties can lead to aspiration and other complications, and a proper evaluation can help determine the safest diet and interventions.
Choice B reason: Placing the client on the hospital's fall precautions protocol is crucial due to the client's orthostatic hypotension and use of a walker. These factors increase the risk of falls, and implementing fall precautions can help prevent injuries.
Choice C reason: Obtaining a prescription for a different antihypertensive medication is not indicated in this scenario. There is no information provided that suggests the current medication is inappropriate or ineffective. The focus should be on managing the client's orthostatic hypotension with non-pharmacological interventions.
Choice D reason: Reminding the nursing staff to place the client in a sitting position during meals is important to reduce the risk of aspiration due to dysphagia. Sitting upright can help ensure that food and liquids are swallowed safely.
Choice E reason: Referring the client for physical and occupational therapy evaluations is necessary to address the client's functional mobility and ability to perform ADLs. These therapies can help optimize the client's independence and safety.
Choice F reason: Placing the client on a liquid diet to prevent choking is not appropriate without a swallowing evaluation. The speech-language pathologist should determine the safest diet based on the client's specific needs and swallowing abilities.
Choice G reason: Performing orthostatic blood pressure checks is important for monitoring and managing the client's orthostatic hypotension. Regular checks can help identify changes in blood pressure and guide interventions to prevent falls and related complications.

Choice A reason: This statement is incorrect because the combination of heparin and warfarin does not dissolve the blood clot faster. Instead, these medications have different mechanisms of action. Heparin works quickly to prevent further clot formation, while warfarin takes several days to reach therapeutic levels and maintain anticoagulation over the long term.
Choice B reason: While the risk of a blood clot in the lungs (pulmonary embolism) is a concern, the necessity of using both heparin and warfarin is not because of the need for multiple blood thinners but rather due to their complementary pharmacokinetics. Heparin provides immediate anticoagulation, whereas warfarin requires time to become effective.
Choice C reason: This statement is also incorrect. Heparin does not dissolve clots but works to prevent the extension of existing clots and the formation of new ones. Warfarin, likewise, does not dissolve clots but prevents further clot formation by inhibiting vitamin K-dependent clotting factors.
Choice D reason: This is the accurate response. Heparin works immediately, providing rapid anticoagulation, which is essential for acute management of venous thromboembolism. On the other hand, warfarin takes several days to achieve its anticoagulant effect because it works by inhibiting the synthesis of vitamin K-dependent clotting factors. Therefore, the patient is initially placed on heparin to provide immediate protection against clotting while warfarin is started simultaneously. Once warfarin reaches a therapeutic level, heparin can be discontinued, and warfarin can maintain long-term anticoagulation.