Which of the following considerations are important for a nurse administering morphine and oxybutynin to a client with renal calculi? (Select all that apply)

A. Referring the client to the charge nurse does not provide the necessary education and may leave the client confused or anxious; the nurse should provide an immediate, accurate explanation.
B. Heparin and warfarin do not dissolve clots; they prevent clot extension and formation of new clots, allowing the body’s natural fibrinolytic system to break down existing clots.
C. Heparin is continued temporarily because warfarin takes several days (usually 4–5 days) to achieve a therapeutic INR level. This overlap ensures continuous anticoagulation and reduces the risk of clot propagation while waiting for warfarin’s effect.
D. Heparin does not enhance warfarin’s effect directly; its role is to provide immediate anticoagulation until warfarin becomes effective.

A. Massaging the injection site after heparin administration is inappropriate because it can cause bruising or hematoma formation due to the anticoagulant effect.
B. A 22-gauge needle is too large for subcutaneous heparin injections; smaller needles (25–27 gauge) are recommended to minimize tissue trauma.
C. A 1-inch needle is generally too long for subcutaneous injections and increases the risk of intramuscular injection; a ⅜- to ⅝-inch needle is preferred.
D. The abdomen above the iliac crest is the preferred site for subcutaneous heparin injections because it provides adequate subcutaneous tissue, allows for proper absorption, and reduces the risk of bleeding or bruising compared to other sites.