A nurse is completing a home care visit for a 75-year-old client who began enoxaparin sodium (Lovenox) therapy 2 weeks ago.

The nurse is providing teaching regarding managing a bleeding episode in the event of an accidental injury with the client and his spouse.

Which of the following statements by the spouse indicates a need for further teaching?

Choice A rationale

Swelling of a lower extremity is a primary sign of a Deep Vein Thrombosis (DVT), the condition that predisposes a client to a pulmonary embolus (PE). A PE occurs when a thrombus (often from a DVT) embolizes to the pulmonary vasculature. Monitoring for DVT symptoms is essential, but the hallmark sign of the resultant PE is respiratory compromise.

Choice B rationale

A burning sensation when voiding (dysuria) is a classic symptom of a Urinary Tract Infection (UTI), due to irritation and inflammation of the bladder lining (cystitis) or urethra. This finding is entirely unrelated to a pulmonary embolus, which involves the cardiovascular and respiratory systems when an embolus lodges in the pulmonary arteries.

Choice C rationale

Sudden shortness of breath (dyspnea) is the most common and often dramatic symptom of a pulmonary embolus. This acute symptom arises from the occlusion of the pulmonary arteries by the embolus, which leads to a severe ventilation/perfusion (V/Q) mismatch and subsequent hypoxemia and rapid respiratory distress.

Choice D rationale

Purulent drainage at a suture line is the definitive local sign of a Surgical Site Infection (SSI), which indicates a bacterial invasion and inflammatory response in the wound bed. This finding relates to local wound healing complications and has no direct causal relationship with the development or signs of a pulmonary embolus.

Choice A rationale

Aspirin (acetylsalicylic acid) at a low daily dose of 81 mg is typically used for its antiplatelet effects (irreversible inhibition of COX-1 in platelets) to prevent cardiovascular events. This dose has minimal analgesic or anti-inflammatory effects. Therefore, monitoring a pain rating of 6 or more is not a primary concern for this specific prophylactic indication.

Choice B rationale

Encouraging increased intake of green leafy vegetables, which are rich in Vitamin K, is relevant for clients on warfarin (Coumadin), as Vitamin K can counteract its effect. Aspirin, however, works on platelet aggregation and is not affected by dietary Vitamin K levels. This advice is irrelevant to the pharmacodynamics of aspirin.

Choice C rationale

Aspirin is a non-steroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal irritation and bleeding, a side effect that is dose-dependent but still possible with low-dose therapy. Black, tarry stools (melena) are an indication of upper gastrointestinal bleeding due to the degradation of hemoglobin to hematin. The nurse must monitor for this serious adverse effect.

Choice D rationale

Aspirin, especially at higher doses, can impair renal function by inhibiting prostaglandin synthesis, which is essential for maintaining renal blood flow. This effect typically leads to an increase (not a sudden drop) in blood urea nitrogen (BUN) (normal range 8-20 mg/dL) and creatinine (normal range 0.6-1.2 mg/dL) levels due to decreased glomerular filtration.