The nurse evaluates a client with a right leg deep vein thrombosis (DVT) to determine if treatment is effective. Which findings indicate that treatment is not therapeutic? Select all that apply.

Management of a deep vein thrombosis (DVT) in the right leg involves anticoagulation therapy, most commonly with agents such as Heparin, to prevent clot extension and reduce the risk of pulmonary embolism. Evaluation of therapeutic effectiveness focuses on stabilization or reduction of clot-related symptoms and prevention of new thromboembolic events. Any signs of new clot formation, impaired anticoagulant delivery, or systemic embolization indicate treatment failure or complications requiring urgent intervention. Rationale: A. Infiltration of the IV site delivering heparin indicates interruption of anticoagulant therapy. If heparin is not properly infusing into the bloodstream, therapeutic anticoagulation levels will not be maintained, increasing the risk of clot progression or new thrombus formation. This represents ineffective treatment delivery and requires immediate correction of IV access. B. Swelling, redness, and pain in the left calf suggest development of a new DVT in the contralateral leg. This indicates that anticoagulation therapy is not effectively preventing clot formation. New thrombotic symptoms during treatment demonstrate that the condition is not adequately controlled and is worsening. C. A reduction in leg circumference from 44 cm to 38 cm indicates improvement in edema and clot resolution. Decreased swelling suggests that venous return is improving and the thrombus is responding to anticoagulation therapy. This is a positive therapeutic outcome rather than a sign of treatment failure. D. Sudden shortness of breath and difficulty breathing are classic warning signs of a pulmonary embolism, a life-threatening complication of DVT. This indicates that part of the clot may have dislodged and traveled to the lungs despite treatment. It reflects a failure of therapy to prevent embolic complications and requires immediate emergency intervention. E. Prolonged bleeding from a minor skin tear suggests that the anticoagulant effect may actually be therapeutic or potentially excessive. This finding requires monitoring, but it indicates that heparin is affecting coagulation as intended rather than showing treatment failure. It is not an indicator of ineffective therapy.