A nurse should identify which of the following as ways to make a positive impact in reducing health disparities in the clients they care for?

A. This response addresses the timeframe for heparin to achieve therapeutic levels in the bloodstream, not its action on dissolving clots. Heparin works primarily by inhibiting the formation of new clots and preventing existing clots from enlarging or propagating, rather than directly dissolving existing clots.
B. This statement accurately describes the mechanism of action of heparin. Heparin is an anticoagulant that works by enhancing the activity of antithrombin III, which inhibits the clotting factors thrombin and factor Xa. This action prevents the formation of new clots and stabilizes existing clots, but it does not actively dissolve them.
C. While pharmacists are knowledgeable about medications, including their mechanisms of action, it is within the scope of nursing practice to provide information on how medications work to clients. The nurse should be prepared to explain the basic mechanism of heparin's action to the client in understandable terms.
D. This response is inaccurate regarding heparin's action. Heparin itself does not directly dissolve clots; it prevents further clot formation and allows the body's natural fibrinolytic (clot-dissolving) mechanisms to work on existing clots. Oral medications like warfarin or direct oral anticoagulants (DOACs) may be used after initial heparin therapy to continue anticoagulation, but they do not directly dissolve clots either.

A. An advance directive is a legal document that outlines a person's preferences for medical treatment, including end-of-life care. Asking the client if they have a copy of their advance directive is appropriate because it can provide valuable information about their wishes regarding medical interventions. It allows the nurse to review the document to ensure that the client's current wishes align with what is documented in their advance directive.
B. In most cases, a competent adult's healthcare decisions, including decisions to refuse treatment, are legally binding and cannot be overridden by family members. It is important for the nurse to educate the client about their rights and ensure that their wishes are respected. Family members may be involved in discussions and support the client's decisions, but they cannot override a competent adult's wishes regarding their medical care.
C. While it's important to involve family members in discussions about the client's wishes, especially if they are the client's designated healthcare proxy or legally authorized decision-maker, family agreement is not required for the client's decision to refuse life-saving measures. The nurse should primarily focus on the client's expressed wishes and ensure that these wishes are understood and respected.
D. The provider's agreement with the client's decision may be necessary to document and implement the plan of care accordingly, but ultimately, the decision to refuse treatment rests with the competent client. The nurse should facilitate communication between the client and the provider to ensure that the client's wishes are understood and documented appropriately.