A nurse in the emergency department is planning care for a client who had a myocardial infarction and is receiving thrombolytic therapy with an IV infusion of alteplase. Which of the following interventions should the nurse include in the plan?

Choice A rationale Administering aspirin for fever in a client receiving alteplase is contraindicated. Alteplase is a potent thrombolytic, and aspirin, an antiplatelet agent, would significantly increase the risk of bleeding. If fever is present, acetaminophen would be the preferred antipyretic due to its lack of antiplatelet activity, minimizing the risk of hemorrhage in this high-risk patient. Choice B rationale Ambulation is contraindicated in a client receiving thrombolytic therapy. Alteplase lyses existing clots, increasing the risk of bleeding, especially from sites of trauma or increased pressure. Maintaining bed rest and limiting movement helps to minimize the risk of hemorrhagic complications, such as hematoma formation or internal bleeding, which could be exacerbated by physical activity. Choice C rationale Administering a sodium phosphate enema is contraindicated in a client receiving thrombolytic therapy. Sodium phosphate enemas can cause rectal irritation, mucosal injury, and increased peristalsis, all of which elevate the risk of gastrointestinal bleeding in a patient whose coagulation cascade is already significantly impaired by alteplase. Stool softeners are preferred if constipation is present. Choice D rationale Monitoring for changes in the level of consciousness is a critical intervention for a client receiving alteplase. Intracranial hemorrhage is the most serious and life-threatening complication of thrombolytic therapy. Any alterations in neurological status, such as confusion, disorientation, or decreased responsiveness, could indicate intracranial bleeding and necessitate immediate intervention and discontinuation of the infusion.