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. Sulfa allergy: Inhaled corticosteroids are not sulfonamide-based medications, so a history of sulfa allergy does not increase the risk of adverse effects. Monitoring for allergic reactions related to sulfa is not necessary.

B. Diabetes mellitus: Inhaled corticosteroids can increase blood glucose levels by promoting gluconeogenesis and reducing insulin sensitivity. Clients with diabetes are at risk for hyperglycemia, so closer monitoring of blood glucose is essential while on this medication.

C. Asthma: Asthma is an indication for inhaled corticosteroids rather than a risk factor for adverse effects. While monitoring for effectiveness is important, asthma itself does not necessitate additional safety monitoring beyond standard care.

D. Cataracts: Long-term systemic corticosteroid use is associated with an increased risk of cataracts, but inhaled corticosteroids have a much lower systemic absorption. While eye exams may be part of long-term care, immediate close monitoring is not typically required for cataracts.

• 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.