A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 110 beats per minute and a blood pressure of 90/62 mm Hg. A stat CBC shows a platelet count of less than 50,000, which is a low platelet count. The previous platelet level was 375,000. The nurse will:
Hold the heparin and notify the provider
Request an order for vitamin K (phytonadione)
Request an order for a PTT test
Administer oxygen and notify the provider
The Correct Answer is A
Choice A reason:
Holding the heparin and notifying the provider is the appropriate action. The significant drop in platelet count suggests the possibility of heparin-induced thrombocytopenia (HIT), a serious complication of heparin therapy. Immediate discontinuation of heparin and further evaluation are necessary to manage this condition.
Choice B reason:
Requesting an order for vitamin K (phytonadione) is not appropriate in this scenario. Vitamin K is used to reverse the effects of warfarin, not heparin. The issue here is the potential for HIT, not an over-anticoagulation that requires vitamin K.
Choice C reason:
While requesting a PTT test is part of managing anticoagulation therapy, it is not the immediate priority in this case. The significant drop in platelet count is more concerning for HIT, which requires stopping heparin and notifying the provider for further evaluation.
Choice D reason:
Administering oxygen and notifying the provider is not specific to managing the issue of a significantly low platelet count in a patient on heparin. The primary concern here is the potential for HIT, which necessitates stopping the heparin.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
Abdominal ultrasound and chest X-ray are not the first-line tests for a patient presenting with these symptoms. While they can be useful in assessing certain conditions, the priority in this case is to rule out cardiac causes, especially given the symptoms that could indicate a cardiac event.
Choice B reason:
Testing the acidity of gastric contents and assessing the throat is not relevant for the initial evaluation of these symptoms. While gastrointestinal issues can present with similar symptoms, the first step should be to rule out more serious cardiac causes.
Choice C reason:
Electrocardiogram (EKG) and serum troponin levels are the correct answer. These tests are critical in assessing cardiac function and identifying potential myocardial infarction or other cardiac issues. Given the patient's symptoms, which can be indicative of a cardiac event, these tests are prioritized to rule out any immediate cardiac threats.
Choice D reason:
Abdominal X-ray and colonoscopy are not appropriate first-line tests in this scenario. While they may be necessary later to investigate gastrointestinal issues, the primary concern given the patient's symptoms is to rule out cardiac events with an EKG and serum troponin levels.
Correct Answer is A
Explanation
Choice A reason:
Using a different antifungal agent might be necessary due to the potential interaction between voriconazole and warfarin. Voriconazole can increase the anticoagulant effects of warfarin, leading to an increased risk of bleeding. Therefore, selecting an alternative antifungal that does not interact with warfarin could be the safest option for the patient.
Choice B reason:
Reducing the dose of voriconazole may not adequately address the drug interaction issue. Voriconazole can significantly affect warfarin metabolism even at lower doses, leading to potential complications. Therefore, this choice is less likely to be recommended.
Choice C reason:
Administering intravenous voriconazole does not change its interaction with warfarin. The method of administration does not alter the drug's effect on warfarin metabolism, making this option inappropriate for managing the drug interaction.
Choice D reason:
Increasing the dose of warfarin is not a viable option as voriconazole increases warfarin's anticoagulant effect. This would further elevate the risk of bleeding and is not recommended. Thus, this option is incorrect.
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