A patient at the clinic says, "I always walk after dinner, but lately my leg cramps and hurts after just a few minutes. The pain goes away after I stop walking, though." Which focused assessment would the nurse make?

Choice A reason: This statement is incorrect because the combination of heparin and warfarin does not dissolve the blood clot faster. Instead, these medications have different mechanisms of action. Heparin works quickly to prevent further clot formation, while warfarin takes several days to reach therapeutic levels and maintain anticoagulation over the long term.
Choice B reason: While the risk of a blood clot in the lungs (pulmonary embolism) is a concern, the necessity of using both heparin and warfarin is not because of the need for multiple blood thinners but rather due to their complementary pharmacokinetics. Heparin provides immediate anticoagulation, whereas warfarin requires time to become effective.
Choice C reason: This statement is also incorrect. Heparin does not dissolve clots but works to prevent the extension of existing clots and the formation of new ones. Warfarin, likewise, does not dissolve clots but prevents further clot formation by inhibiting vitamin K-dependent clotting factors.
Choice D reason: This is the accurate response. Heparin works immediately, providing rapid anticoagulation, which is essential for acute management of venous thromboembolism. On the other hand, warfarin takes several days to achieve its anticoagulant effect because it works by inhibiting the synthesis of vitamin K-dependent clotting factors. Therefore, the patient is initially placed on heparin to provide immediate protection against clotting while warfarin is started simultaneously. Once warfarin reaches a therapeutic level, heparin can be discontinued, and warfarin can maintain long-term anticoagulation.

Choice A reason: Asking the nursing assistant to determine if Marvin can safely sit in a bedside chair is not appropriate. Safety assessments, especially for patients with recent neurological events, should be done by a registered nurse or a physical therapist. This ensures that any nuanced clinical signs indicating instability or risk are recognized and addressed promptly.
Choice B reason: Passive range of motion (ROM) exercises are essential for patients with hemiplegia to prevent complications such as muscle atrophy, joint contractures, and decreased circulation. Regularly performing these exercises can maintain the health of the muscles and joints, promote better blood flow, and help in maintaining some degree of flexibility in the affected limbs.
Choice C reason: Assessing neurologic status is crucial in patients who have had a recent stroke and received tPA treatment. Frequent neurologic assessments help in monitoring for any changes or signs of deterioration. This includes checking consciousness, pupil response, motor function, and sensory perception. Changes in these parameters can indicate complications or the need for immediate medical interventions.
Choice D reason: Coordinating with speech therapy for a swallowing evaluation is essential because Marvin has dysphagia. Swallowing assessments by a speech therapist can determine the patient's ability to swallow safely and the appropriate dietary modifications needed to prevent aspiration, a common risk in patients with dysphagia. This is vital to prevent pneumonia or other respiratory complications.
Choice E reason: Using pillows and positioning devices to maintain proper body alignment is important in preventing complications such as pressure ulcers, muscle contractures, and discomfort. Proper positioning can also assist in maintaining better respiratory function and overall comfort. It also prevents the development of deformities and promotes functional posture, which is especially important for patients with hemiplegia.
Choice F reason: Pulling on his arm to position him on his side is inappropriate and can cause injury, especially in a patient with hemiplegia. This technique can lead to shoulder dislocations or increased pain. Instead, proper repositioning techniques using assistive devices and help from additional staff members should be employed to ensure safe and effective movement of the patient.