A nurse is caring for a client who is diagnosed with a deep vein thrombosis (DVT) and is receiving heparin. The client asks the nurse how long it will take for the heparin to dissolve the clot, which of the following responses should the nurse give?
"Depending on the level of your PT/INR, the clot will begin to dissolve."
"After the first dose, the clot will begin to dissolve."
"It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level."
"Heparin does not dissolve clots. It stops new clots from forming."
The Correct Answer is D
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.
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Correct Answer is C
Explanation
A) Beta Blockers: While beta blockers can be used to manage some side effects of various medications, they are not typically indicated for managing niacin-induced flushing. Their primary use is in cardiovascular conditions rather than specifically addressing flushing.
B) Calcium Channel Blockers: Calcium channel blockers are primarily used to treat hypertension and certain heart conditions. They do not specifically address the flushing associated with niacin and would not be the expected choice for this side effect.
C) NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective in managing niacin-induced flushing. Administering an NSAID, such as ibuprofen, prior to taking niacin can help reduce the flushing response by inhibiting the prostaglandins that contribute to this side effect.
D) Fibric Acid Derivatives: These medications, such as gemfibrozil, are used to lower triglycerides and cholesterol levels, but they do not address the flushing side effect caused by niacin. Their mechanism of action is different and not focused on alleviating flushing symptoms.
Correct Answer is ["C","D","E","F"]
Explanation
A) Constipation: While constipation can occur with digoxin use, it is not a classic sign of digoxin toxicity. Therefore, it is less critical for the client to monitor this symptom specifically in relation to toxicity.
B) Dark red urine: Dark red urine is not typically associated with digoxin toxicity. This symptom could indicate other conditions, such as blood in the urine or issues with the kidneys, but it is not a direct manifestation of digoxin toxicity.
C) Bradycardia: Digoxin toxicity can lead to bradycardia, characterized by a slower than normal heart rate. The client should be instructed to monitor their pulse and report any significant changes, especially if the heart rate drops below 60 beats per minute.
D) Nausea: Nausea is a common symptom of digoxin toxicity. Clients should be aware of this and report any persistent or severe nausea, as it may indicate that the digoxin levels in their system are too high.
E) Vomiting: Vomiting is another classic sign of digoxin toxicity. Clients should be instructed to report any episodes of vomiting, as this can further complicate their condition and may require adjustment of their medication.
F) Anorexia: Anorexia, or loss of appetite, can also occur with digoxin toxicity. Clients should be advised to monitor their appetite and report any significant changes, as this can be an early indicator of toxicity.