A nurse is collecting data from a client who is receiving clopidogrel following the placement of a cardiac stent. Which of the following findings should the nurse identify as an adverse effect of this medication?

A. Insert a urinary catheter to determine the residual urine. Inserting a urinary catheter may be necessary to accurately measure urinary output and assess for signs of urinary retention. However, the presence of hematuria suggests a potential bleeding complication related to heparin therapy. While monitoring urinary output is important, inserting a urinary catheter should not be the first action taken in response to hematuria. Other interventions to address the bleeding should be prioritized.

B. Hold the next dose of heparin and contact the physician. This is the correct answer. Hematuria can be a sign of a bleeding complication, which is a known side effect of heparin therapy. Holding the next dose of heparin is appropriate to prevent further bleeding, and contacting the physician ensures prompt evaluation and appropriate management of the patient's condition. The physician may decide to adjust the dose of heparin, temporarily discontinue it, or order further investigations to determine the cause of the hematuria.

C. Instruct the patient to drink adequate amounts of fluid. While maintaining hydration is important for overall health, instructing the patient to drink fluids would not directly address the underlying cause of hematuria, which may be related to a bleeding complication from heparin therapy. Holding the next dose of heparin and contacting the physician are more appropriate actions in response to hematuria.

D. Administer an additional dose of heparin subcutaneously. Administering additional heparin would exacerbate the bleeding risk and is contraindicated in the presence of hematuria. It is important to withhold further doses of heparin and seek medical guidance to address the bleeding complication.

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.