A nurse is completing a home care visit for a 75-year-old client who began enoxaparin sodium (Lovenox) therapy 2 weeks ago. The nurse is providing teaching regarding managing a bleeding episode in the event of an accidental injury with the client and his spouse. Which of the following statements by the spouse indicates a need for further teaching?

Choice A rationale Applying a constrictive bandage wrap to a bleeding site in a client receiving enoxaparin sodium, a low molecular weight heparin that inhibits factor Xa and thrombin generation, may cause a tourniquet effect; this can impede distal blood flow and potentially increase the risk of compartment syndrome, especially with internal bleeding. Direct pressure is preferred initially. Choice B rationale Monitoring the site for re-bleeding is crucial because enoxaparin extends clotting time, necessitating vigilant observation for recurrent hemorrhage after initial control. The standard Activated Partial Thromboplastin Time (aPTT) range is typically 30-40 seconds, and enoxaparin significantly prolongs this, increasing bleeding risk; early detection is essential for intervention. Choice C rationale Elevating the affected area utilizes gravity to decrease hydrostatic pressure in the capillaries and venules of the injured extremity, subsequently promoting venous return and reducing arterial inflow pressure. This physiological mechanism helps to slow the rate of blood loss and reduce local tissue swelling following an injury. Choice D rationale Resting to minimize the risk of re-bleeding reduces physical activity and muscular contractions, which can increase local blood flow and dislodge a forming clot. Reduced movement is vital because enoxaparin impairs the intrinsic clotting cascade, making clot stabilization and maintenance dependent on low pressure and minimal mechanical stress.