A nurse is assessing a client who complains of left shoulder pain after a recent fall.
Which additional symptoms would support the nurse's suspicion of a splenic injury? Select all that apply.

The scenario requires applying knowledge of anticoagulation pharmacology and safety protocols for pulmonary embolism management. Nurses must monitor therapeutic levels, maintain reversal agents, and assess for complications like bleeding to ensure systemic stability and prevent further clot propagation during recovery.

Choice A rationale

Activated partial thromboplastin time measures the intrinsic pathway of coagulation. It is vital for monitoring unfractionated heparin therapy, with a normal range of 30 to 40 seconds. Prolonged values indicate a higher risk for spontaneous hemorrhage.

Choice B rationale

Protamine sulfate acts as a specific antagonist to neutralize the anticoagulant effects of heparin. Availability is critical for immediate reversal if life threatening bleeding occurs or if the activated partial thromboplastin time exceeds the safe therapeutic range.

Choice C rationale

The international normalized ratio assesses the extrinsic pathway, primarily for warfarin therapy. A normal range for healthy individuals is 0.8 to 1.2, but therapeutic targets for pulmonary embolism typically fall between 2.0 and 3.0.

Choice D rationale

Hematocrit and platelet levels indicate bone marrow function and blood volume. Significant drops in hematocrit suggest internal bleeding, while platelet monitoring is essential to detect heparin induced thrombocytopenia, a serious immune mediated complication of anticoagulant use.

Choice E rationale

Phytonadione, or Vitamin K, is the essential reversal agent for warfarin induced anticoagulation. It promotes the hepatic synthesis of clotting factors 2, 7, 9, and 10, effectively counteracting excessive anticoagulation and reducing the risk of hemorrhage.

Choice F rationale

Continuous physical assessment is necessary to identify early signs of coagulopathy. These include petechiae, ecchymosis, hematuria, or bleeding gums. Early detection allows for prompt dosage adjustments or the administration of reversal agents to prevent clinical deterioration.

This scenario requires evaluating medical orders against a client's specific allergy profile to morphine, iodine, and codeine. Knowledge of hypersensitivity reactions to intravenous contrast media and the safe selection of analgesics is necessary to ensure patient safety and prevent potentially fatal allergic responses.

Choice A rationale

Iodine is a primary component of many intravenous contrast agents used in imaging. The client's documented iodine allergy necessitates questioning this order to avoid life-threatening systemic reactions, such as angioedema or airway obstruction, typically associated with radiopaque medium exposure.

Choice B rationale

Therapeutic lifestyle changes, including dietary modifications, are foundational in stroke prevention. Reducing dietary fats and cholesterol helps mitigate cardiovascular risk factors, supporting the long-term management of transient ischemic attacks without conflicting with the client's specific known drug allergies.

Choice C rationale

Protocol-based vital sign monitoring ensures the early detection of neurological or hemodynamic instability. This order is a standard of care for any patient presenting with cerebrovascular symptoms and carries no risk related to the client's iodine or opioid sensitivities.

Choice D rationale

Acetaminophen belongs to the para-aminophenol derivative class of medications. It does not possess the structural components of phenanthrene alkaloids like morphine or codeine, making it a safe alternative for treating mild to moderate pain in opioid-allergic individuals..