The nurse is preparing to administer enoxaparin 30 mg subcutaneously using a pre-filled syringe containing 30 mg in 0.3 mL. Which action should the nurse implement?

Rationale for Correct Choices:

• Alcoholic cirrhosis: The client has a history of chronic heavy alcohol use, jaundice, RUQ tenderness, a distended abdomen, and abnormal liver ultrasound findings, all consistent with alcoholic cirrhosis. The presence of regenerative nodules and a nodular liver surface on imaging further supports this diagnosis.
• Aspartate aminotransferase (AST): The AST is elevated at 120 U/L (normal range: 10–40 U/L), which commonly occurs in alcoholic liver disease. In alcoholic cirrhosis, AST levels often exceed ALT and indicate ongoing hepatocellular injury.
• Ammonia: The client’s ammonia level is elevated at 90 mcg/dL (normal: 15–45 mcg/dL), suggesting impaired hepatic clearance and early signs of hepatic encephalopathy, both seen in advanced liver disease such as cirrhosis.

Rationale for Incorrect Choices:

• Acute pancreatitis: The client does not report severe epigastric pain radiating to the back, which is typical for pancreatitis. There is also no elevation of serum lipase or amylase, and imaging does not show pancreatic inflammation or edema.
• Hepatitis A: Hepatitis A usually presents with acute onset of symptoms like fever, malaise, and dark urine. It is typically short-term and not associated with the chronic liver changes (nodular liver, regenerative nodules) found in this client.
• Chloride: While slightly elevated, the chloride level is not specific to liver disease and has minimal diagnostic value in cirrhosis. It is not typically used as a marker for hepatic dysfunction or alcoholic liver disease.
• White blood cell count: The WBC count is elevated (16,000/mm³), but this can be attributed to various causes such as inflammation or infection. It does not specifically support the diagnosis of cirrhosis like AST and ammonia levels do.

Rationale:

A. Instruct the client to shower and wash her hair thoroughly: Decontamination by showering is essential to remove any anthrax spores from the skin and hair. Thorough washing reduces the risk of further spread and protects healthcare personnel and other patients.

B. Clean all surfaces touched by the client with vinegar and water: Vinegar and water are not effective against anthrax spores. Proper decontamination requires specific agents, such as a 0.5% hypochlorite (bleach) solution, under the guidance of hazardous materials protocols.

C. Place the client in a room with lead doors to contain airborne anthrax: Lead doors are used for radiation containment, not for biological threats like anthrax. Anthrax is not typically airborne unless aerosolized, so this intervention is unnecessary and ineffective.

D. Bag the clothes the client is wearing in plastic bags: Contaminated clothing can carry anthrax spores. Placing clothes in sealed plastic bags is a critical step in preventing environmental contamination and ensuring safe disposal.

E. Place the client on airborne precautions: While anthrax is not usually spread from person to person, airborne precautions are used if aerosol exposure is suspected, as in bioterrorism events. This helps contain spores until full decontamination is completed.