A 65-year-old female client with a long history of acute coronary syndrome (ACS) had two cardiac stents placed via percutaneous coronary intervention. After this procedure, she was started on aspirin 325 mg orally once daily and clopidogrel 75 mg orally once daily. The nurse is preparing to provide education about each of these drugs.

For each health teaching statement below, click a box to indicate whether it is Essential (necessary or appropriate drug information) or Unrelated (not relevant or appropriate drug information) for the client.

A. "The anticoagulant effect of a single dose of aspirin can last for as long as a month." This statement is incorrect. While aspirin has antiplatelet effects that inhibit blood clot formation, its duration of action is not as long as a month. Aspirin irreversibly inhibits the enzyme cyclooxygenase (COX), thereby inhibiting platelet aggregation. However, the effects on platelet function are not permanent, and platelets turnover within a few days, thus the anticoagulant effect of a single dose of aspirin typically lasts for a shorter duration.

B. "The anticoagulant effect of a single dose of aspirin can last for as long as a day." Aspirin's primary effect is on platelets, not directly on overall blood clotting. It inhibits the COX enzyme, reducing the production of thromboxane A2, a chemical that promotes platelet aggregation. The initial inhibition of platelet function is strongest within the first 24 hours after taking aspirin. However, the affected platelets remain dysfunctional for their entire lifespan (around 7-10 days).

C. "The anticoagulant effect of a single dose of aspirin can last for as long as a week." This statement is correct. Aspirin's effect on platelets is due to its irreversible inhibition of the COX enzyme. Platelets have a lifespan of about 7-10 days. Once a platelet is affected by aspirin, it cannot regain its function. As your body continuously produces new platelets, the overall antiplatelet effect gradually diminishes over time.

D. "The anticoagulant effect of a single dose of aspirin can last for as long as 12 hours."

Rationale: This statement is partially correct. The antiplatelet effect of aspirin does not typically last as short as 12 hours. While the peak inhibition of platelet function occurs within hours after administration, the duration of action is longer due to the irreversible inhibition of COX-1. However, stating that it lasts exactly 12 hours may not be entirely accurate for all individuals, as the duration of action can vary depending on factors such as individual metabolism and dose.

A. Easy bruising indicates the medication is effective: While some bruising is possible, excessive bruising doesn't necessarily mean the medication is working effectively. It could indicate excessive anticoagulation, requiring dose adjustments.

B. Inject the medication deep into the thigh muscle: Heparin is injected subcutaneously, targeting the fatty tissue layer just beneath the skin. Injecting into the muscle can be painful and decrease absorption.

C. Expect stools to become black and tarry: Black stools can be a sign of upper gastrointestinal bleeding, a potential but uncommon side effect. The nurse should instruct the client to report any black stools but not expect them as a normal occurrence.

D. Use a soft bristle toothbrush: This is important because heparin increases bleeding risk, and a soft-bristled toothbrush minimizes gum irritation and potential bleeding.