The nurse is caring for a client who has been taking milrinone for 3 months. Which clinical finding indicates the client is experiencing an adverse effect of the drug?

A. Bleeding: Heparin enhances the activity of antithrombin III, which inhibits clotting factors and prolongs clotting time. This mechanism increases the risk for bleeding, making it the most common and clinically significant adverse effect requiring close monitoring.

B. Hyperglycemia: Heparin does not interfere with insulin secretion or glucose metabolism. Elevated blood glucose levels are more commonly associated with corticosteroids, stress responses, or uncontrolled diabetes rather than anticoagulant therapy.

C. Constipation: Heparin does not affect gastrointestinal motility. Constipation is more frequently linked to opioid analgesics, anticholinergic medications, or reduced fluid and fiber intake.

D. Thrombus: Heparin is used to prevent and treat thrombus formation by inhibiting coagulation pathways. While heparin-induced thrombocytopenia can paradoxically increase clot risk, thrombus formation is not a typical direct side effect.

• 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.