A nurse sustained a needlestick injury from a patient whose human immunodeficiency virus (HIV) status was unknow. The nursing supervisor is notified, an incident report is generated, and a post-HIV exposure prophylaxis checklist is started for this nurse. Which implementation will be the first to perform?

A. "It eliminates the clotting factors." - This statement suggests a misunderstanding of how enoxaparin works. Enoxaparin is a low molecular weight heparin that does not eliminate clotting factors but rather inhibits the activity of factor Xa, a key enzyme involved in the coagulation cascade. By inhibiting factor Xa, enoxaparin prevents the conversion of prothrombin to thrombin, thereby reducing the formation of fibrin clots. It does not eliminate existing clotting factors from the bloodstream.

B. "This medication will keep the blood clot from growing larger." - This statement demonstrates a correct understanding of enoxaparin's mechanism of action. Enoxaparin is an anticoagulant medication that works by preventing the enlargement of existing blood clots. By inhibiting the activity of factor Xa, enoxaparin prevents the conversion of prothrombin to thrombin, thereby reducing the formation of fibrin clots and preventing existing clots from growing larger.

C. "This medication will decrease my risk for bleeding." - This statement is incorrect. Enoxaparin, like other anticoagulants, actually increases the risk of bleeding due to its mechanism of action. By inhibiting the coagulation cascade, enoxaparin prolongs the time it takes for blood to clot, which can lead to an increased risk of bleeding, particularly in patients who are predisposed to bleeding or are taking other medications that affect clotting.

D. "I will get this medication in my veins." - This statement is incorrect. Enoxaparin is administered subcutaneously, not intravenously. It is usually injected into the fatty tissue of the abdomen or thigh using a prefilled syringe with a short, thin needle. The subcutaneous route of administration allows for slow absorption and sustained anticoagulant effects over time.

A. Chest pain that radiates to the jaw:
This finding suggests myocardial ischemia, as chest pain (angina) that radiates to the jaw is a classic symptom of cardiac origin. It is known as referred pain and occurs because the nerves that innervate the heart and jaw have a similar sensory pathway. The pain may be described as pressure, squeezing, or tightness in the chest, and it often spreads to the neck, shoulders, arms, or jaw. This pattern of pain radiation is typical in myocardial ischemia or heart attack due to inadequate blood supply to the heart muscle.

B. Sudden and severe abdominal pain:
While abdominal pain can be associated with various conditions, sudden and severe abdominal pain is not a typical symptom of myocardial ischemia. Instead, it may indicate other abdominal issues such as gastrointestinal problems, pancreatitis, or intra-abdominal vascular events. Myocardial ischemia typically presents with chest pain or discomfort, rather than abdominal pain.

C. Blurred vision:
Blurred vision is not a typical symptom of myocardial ischemia. It may suggest ocular issues such as refractive errors, dry eyes, or conditions affecting the retina or optic nerve. Myocardial ischemia primarily manifests with symptoms related to the heart, such as chest pain, shortness of breath, or other signs of cardiovascular compromise.

D. Dry cough:
A dry cough is not a typical symptom of myocardial ischemia. It may be associated with various respiratory conditions such as allergies, asthma, or respiratory infections. Myocardial ischemia primarily presents with symptoms related to the heart and cardiovascular system, such as chest pain, palpitations, or dyspnea.