A client who has just experienced a pulmonary embolism is administered alteplase (Activase). Which of the following side effects associated with this medication would the nurse assess for?
pancytopenia
Hypertension
Hypokalemia
Internal bleeding
The Correct Answer is D
A) Pancytopenia: While some medications can cause pancytopenia, it is not a common or direct side effect of alteplase. This condition involves a reduction in red blood cells, white blood cells, and platelets, and is not typically associated with thrombolytics.
B) Hypertension: Alteplase is not known to cause hypertension. In fact, the goal of administering alteplase in the context of a pulmonary embolism is to dissolve the clot and restore normal blood flow, which may help stabilize blood pressure.
C) Hypokalemia: This condition, characterized by low potassium levels, is not a common side effect of alteplase. There are other medications that may cause electrolyte imbalances, but alteplase itself is not typically linked to hypokalemia.
D) Internal bleeding: This is a significant risk associated with alteplase, as it is a thrombolytic agent that dissolves clots. The nurse should closely monitor for signs of internal bleeding, such as changes in vital signs, unexplained bruising, or blood in urine or stool. This is the most critical side effect to assess for in a client receiving alteplase
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Correct Answer is D
Explanation
A. "Depending on the level of your PT/INR, the clot will begin to dissolve.": This response is misleading, as heparin's effect is not primarily monitored by PT/INR; rather, heparin is monitored by activated partial thromboplastin time (aPTT). Moreover, heparin does not directly dissolve clots; it prevents further clot formation.
B. "After the first dose, the clot will begin to dissolve.": This statement inaccurately suggests that heparin has an immediate effect on dissolving existing clots. While heparin acts quickly to inhibit further clotting, it does not lead to the dissolution of clots after the first dose.
C. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level.": This is not accurate for heparin, which has an immediate effect on coagulation. While the therapeutic effects can be optimized over several days, heparin begins to work right away to prevent further clotting.
D. "Heparin does not dissolve clots. It stops new clots from forming.": This response accurately describes the mechanism of action of heparin. Heparin prevents the extension of existing clots and the formation of new clots, but it does not actively dissolve clots. This clarification is essential for the client’s understanding of their treatment and expectations regarding DVT management.
Correct Answer is A
Explanation
A) Gallstones: Gemfibrozil is associated with an increased risk of gallstones. This medication can alter the metabolism of lipids and bile, potentially leading to the formation of gallstones. Clients should be monitored for symptoms such as abdominal pain or discomfort that could indicate gallbladder issues.
B) Decreased PT time: Gemfibrozil does not typically affect prothrombin time (PT). Instead, it may interact with anticoagulants and potentially increase PT time, requiring careful monitoring in patients taking both medications.
C) Hyperkalemia: While hyperkalemia can occur with certain lipid-lowering medications, it is not a common side effect associated with gemfibrozil. This drug primarily affects triglycerides and cholesterol levels without significantly impacting potassium levels.
D) Increased creatinine clearance: Gemfibrozil is not known to increase creatinine clearance; in fact, it can sometimes affect renal function. Monitoring kidney function is important, but increased creatinine clearance is not an expected outcome with this medication.