A nurse is teaching a client who has DVT and is prescribed warfarin.

Which of the following instructions should the nurse include in the teaching?

The correct answer is choice A.Warmth and erythema in the affected leg are signs of inflammation and possible infection caused by deep vein thrombosis (DVT), a condition in which blood clots form in veins located deep inside the body, usually in the thigh or lower legs.

The nurse should report this finding to the provider as it may indicate a serious complication.

Choice B is wrong because a negative Homans’ sign, which is the absence of pain in the calf when the foot is dorsiflexed, does not rule out DVT.This sign is unreliable and nonspecific for DVT diagnosis.

Choice C is wrong because decreased calf circumference is not a typical symptom of DVT.In fact, DVT may cause swelling of the affected leg due to impaired blood flow.

Choice D is wrong because pallor and coolness in the affected leg are more indicative of arterial occlusion, which is a blockage of blood flow in an artery, rather than venous occlusion, which is a blockage of blood flow in a vein.

Normal ranges for D-dimer blood test, which measures a substance in the blood that’s released when a blood clot dissolves, are less than 0.5 mcg/mL or 500 ng/mL.High levels of D-dimer may indicate DVT or other conditions that cause blood clots.

The correct answer is A. How to administer LMWH subcutaneously.LMWH is a class of anticoagulant medications that are used to prevent and treat blood clots, such as DVT and PELMWH can be given subcutaneously and does not require frequent blood tests to monitor coagulation, unlike unfractionated heparinTherefore, the nurse should teach the client how to inject LMWH into the fatty tissue under the skin, usually in the abdomen or thigh, using a prefilled syringe.

B. The need for frequent blood tests to monitor coagulation.This statement is wrong because LMWH has more predictable pharmacokinetics and anticoagulant effect than unfractionated heparin, and does not require routine monitoring of APTT or anti-factor Xa levelsHowever, some patients may need monitoring in special situations, such as extremes of weight, renal impairment, or pregnancy.

C. The signs and symptoms of heparin-induced thrombocytopenia (HIT).This statement is wrong because HIT is a rare but serious complication of heparin therapy that causes a drop in platelet count and an increased risk of thrombosisHIT is more common with unfractionated heparin than with LMWH, but it can still occur with LMWH in some casesTherefore, the nurse should inform the client about the signs and symptoms of HIT, such as fever, chills, rash, bleeding, bruising, or new or worsening clots, and advise them to seek medical attention if they occur.

D. The antidote for LMWH in case of overdose.This statement is wrong because there is no specific antidote for LMWH in case of overdose or bleeding complicationsUnlike unfractionated heparin, which can be reversed with protamine sulfate, LMWH has only partial reversal with protamine sulfate and may require other measures such as transfusion of blood products or use of recombinant factor VIIaTherefore, the nurse should instruct the client to follow the prescribed dose and schedule of LMWH and to report any signs of bleeding or overdose, such as nosebleeds, gum bleeding, blood in urine or stool, or excessive bruising.