Heparin is a potent anticoagulant used to treat thrombophlebitis. Its primary and most dangerous adverse effect is bleeding. An overdose exacerbates this risk, leading to signs of hemorrhage. The nurse must monitor for clinical indicators of excessive anticoagulation. Hematuria (blood in the urine), ecchymosis (unexplained bruising), and epistaxis (nosebleed) are all classic, direct signs of bleeding. Other signs include bleeding gums, tarry stools (melena), and petechiae. Prompt identification of these symptoms is critical for patient safety, especially in the postpartum period where the risk of hemorrhage is already elevated.

A. Dysuria (painful urination) is a classic symptom of a urinary tract infection, not a direct sign of heparin overdose.

B. This option incorrectly includes dysuria. While hematuria and epistaxis are correct, the presence of an incorrect sign makes the entire option less accurate.

C. This option incorrectly includes vertigo. Vertigo is not a primary sign of heparin overdose, though it could be a late symptom of hypovolemia from major blood loss.

1. Lilley, L. L., Rainforth, S. J., & Snyder, J. S. (2021). Pharmacology and the Nursing Process (10th ed.). Elsevier. In Chapter 26, "Anticoagulants," the text identifies bleeding as the main complication of heparin therapy, with signs including hematuria, melena, petechiae, ecchymoses, and gum or mucous membrane bleeding (p. 429).

2. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2018). Maternal Child Nursing Care (6th ed.). Elsevier. In Chapter 22, "Postpartum Complications," the nursing care plan for thromboembolic disease emphasizes assessing for evidence of bleeding, such as bleeding gums, nosebleeds, easy bruising, and hematuria, in clients receiving anticoagulant therapy (p. 549).

3. Hirsh, J., & Raschke, R. (2004). Heparin and Low-Molecular-Weight Heparin: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 126(3suppl), 188S–203S. This guideline identifies bleeding as the major complication of heparin therapy and discusses the clinical spectrum of bleeding events, which includes hematuria and spontaneous ecchymoses. (Section: "Complications of Heparin Therapy," p. 196S). https://doi.org/10.1378/chest.126.3suppl.188s