A nurse is caring for a client who is receiving intravenous heparin therapy for deep vein thrombosis. The nurse evaluates for side effects of this drug by observing for:
Petechiae
Slowing pulse rate
Confusion
Pruritus
The Correct Answer is A
Rationale:
A. Petechiae are small, pinpoint red or purple spots on the skin that may indicate bleeding or thrombocytopenia, which can be a side effect of heparin therapy.
B. Slowing pulse rate is not typically associated with heparin therapy.
C. Confusion is not typically associated with heparin therapy.
D. Pruritus (itching) is not typically associated with heparin therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Tenormin (Atenolol) is a beta-blocker that reduces the heart rate and may affect the results of the stress test. Therefore, it should be held the morning of the test.
B. Heparin is an anticoagulant and is not typically held before a stress test.
C. Keflex (Cephalexin) is an antibiotic and is not typically held before a stress test.
D. Holding all medications is not necessary for a stress test, but specific medications that may interfere with the test, such as beta-blockers, should be held.
Correct Answer is D
Explanation
Rationale:
A. This is not correct since a sinus tachycardia show have a sinus P wave unlike in the strip.
B. This is incorrect since a junctional rhythm should have a regular ventricular rhythm unlike in the above strip which is irregular.
C. A first degree heart block should have a PR interval greater than 0.20 without a disruption in the atrial to ventricular conduction.
D. This is correct since the rhythm is irregular and the P waves are absent.
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