A client has a prescription for heparin 1,000 units IV STAT. Several pre-filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement?

Request a prescription to change the route of administration and use the available heparin.

Calculate and administer the equivalent dose of the available low molecular weight heparin.

Advise the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately.

Dilute the available heparin in 250 mL of normal saline solution prior to IV administration.

Answer and Explanation

The Correct Answer is C

A) Request a prescription to change the route of administration and use the available heparin:
Changing the route of administration without a prescription is not within the nurse's scope of practice and could lead to medication errors or adverse effects. It's essential to follow the prescribed route of administration to ensure patient safety.

B) Calculate and administer the equivalent dose of the available low molecular weight heparin:
Low molecular weight heparin (LMWH) has different dosing and potency compared to unfractionated heparin. Calculating an equivalent dose without a specific conversion ratio could result in under- or overdosing, leading to ineffective anticoagulation or increased risk of bleeding.

C) Advise the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately:
This is the correct action. Since the prescription specifies unfractionated heparin administered intravenously, the nurse should notify the pharmacy to provide the correct medication promptly. Using a different form of heparin could lead to dosing errors or ineffective treatment.

D) Dilute the available heparin in 250 mL of normal saline solution prior to IV administration:
This action is not appropriate because it assumes that the available heparin is suitable for intravenous administration, which may not be the case. Dilution may also alter the concentration and potency of the medication, leading to inaccurate dosing and potential adverse effects.

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Correct Answer is B

Explanation

A) Schedule both medications at bedtime:
Administering both medications at bedtime may not be the most appropriate schedule. PTU is typically administered multiple times a day to maintain consistent therapeutic levels in the bloodstream. Additionally, administering Lugol’s solution at bedtime may not provide sufficient time for the iodine to take effect before the PTU.

B) Administer iodine one hour before PTU:
This option is correct. Lugol’s solution, a strong iodine solution, is often given before antithyroid medications such as PTU or methimazole to temporarily block thyroid hormone production. Administering iodine about one hour before PTU allows the iodine to be taken up by the thyroid gland, effectively reducing thyroid hormone synthesis before the PTU starts to inhibit the conversion of T4 to T3.

C) Give parental dose once every 24 hours:
This option does not address the timing of administration between PTU and Lugol’s solution. While it may be correct for the dosing frequency of PTU, it does not specify when to administer Lugol’s solution in relation to PTU.

D) Offer both drugs together with a meal:
Administering both drugs together with a meal may not be appropriate, especially considering that Lugol’s solution needs to be absorbed into the bloodstream to exert its effect on the thyroid gland. Administering Lugol’s solution and PTU together may not allow adequate time for the iodine to take effect before the PTU starts to inhibit thyroid hormone production.

A. Platelets. B. Osmolality. C. Glucose D. Calcium

Correct Answer is B

Explanation

A) Platelets:
Platelet levels are not directly affected by antidiuretic hormone (ADH) administration or diabetes insipidus. Platelet monitoring is important in assessing clotting function but is not specifically related to the management of diabetes insipidus or ADH therapy.

B) Osmolality:
This is the correct answer. Osmolality refers to the concentration of solutes in the blood and is a critical parameter to monitor in clients receiving ADH therapy for diabetes insipidus. ADH regulates water reabsorption in the kidneys, thereby affecting blood osmolality. Monitoring serum osmolality helps assess the effectiveness of ADH therapy in maintaining fluid balance and preventing excessive urine output.

C) Glucose:
While glucose monitoring is important in clients with diabetes mellitus, it is not directly related to diabetes insipidus or ADH therapy. Diabetes insipidus is characterized by excessive thirst and urination due to inadequate ADH production or response, which does not involve glucose metabolism.

D) Calcium:
Calcium levels are not typically affected by ADH therapy or diabetes insipidus. Monitoring calcium levels is important in conditions such as hyperparathyroidism or hypoparathyroidism but is not directly relevant to the management of diabetes insipidus.

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A client has a prescription for heparin 1,000 units IV STAT. Several pre-filled syringes of low molecular weight heparin are available in the client's medication drawer. Which action should the nurse implement?

Nursing Test Bank

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