A nurse is caring for a client who has pulmonary embolism and is receiving alteplase via continuous IV infusion.The nurse should monitor for which adverse effects of this medication? (Select all that apply.)

The nurse should include headache and dyspnea as potential adverse effects of bivalirudin.According to the drug information from various sources, bivalirudin can cause common side effects such as headache, nausea, low or high blood pressure, chest pain, abdominal pain, and shortness of breath (dyspnea).

These side effects should be reported to the provider if they are severe or persistent.

Choice B is wrong because fever is not a common side effect of bivalirudin.

However, fever can be a sign of infection or an allergic reaction to the drug, which should be reported to the provider immediately.

Choice C is wrong because chest pain is not an adverse effect of bivalirudin, but rather a symptom of angina, which is one of the conditions that bivalirudin is used to treat.

Chest pain can also indicate a heart attack or other serious cardiac problems, which require immediate medical attention.

Choice D is wrong because backache is not a common side effect of bivalirudin.

However, backache can be a sign of bleeding in the kidneys or other organs, which can be a serious complication of bivalirudin therapy.

Therefore, any unusual pain or swelling in the back or abdomen should be reported to the provider as soon as possible.

The correct answer is choice D) Use a soft-bristled toothbrush.

This is because enoxaparin (Lovenox) is an anticoagulant that prevents blood clots by thinning the blood.Therefore, patients who take enoxaparin should avoid activities that can cause bleeding, such as using a hard-bristled toothbrush, flossing, shaving, or cutting their nails.

Choice A) Avoid foods that are high in vitamin K is wrong because vitamin K interacts with warfarin, another anticoagulant, but not with enoxaparin.Vitamin K helps the blood clot, so patients who take warfarin should avoid foods that are high in vitamin K, such as leafy green vegetables, broccoli, or liver.

Choice B) Administer injections into areas with decreased subcutaneous tissue is wrong because enoxaparin should be injected into areas with adequate subcutaneous tissue, such as the abdomen or the thighs.Injecting into areas with decreased subcutaneous tissue can cause bruising, pain, or hematoma formation.

Choice C) Massage injection sites after administration is wrong because massaging the injection sites can cause bleeding, bruising, or irritation.Patients who take enoxaparin should not rub or press on the injection sites after administration.