A nurse is administering protamine sulfate to a client who has received an overdose of heparin. What are some important nursing considerations for this medication?

Protamine sulfate should be given slowly intravenously within 30 minutes of heparin administration.

Protamine sulfate should be given rapidly intramuscularly within 60 minutes of heparin administration.

Protamine sulfate should be given slowly intravenously within 60 minutes of heparin administration.

Protamine sulfate should be given rapidly intramuscularly within 30 minutes of heparin administration.

Answer and Explanation

The Correct Answer is A

Protamine sulfate should be given slowly intravenously within 30 minutes of heparin administration. This is because protamine sulfate is a strong base that neutralizes the anticoagulant effect of heparin, which is a strong acid. Protamine sulfate should be given within 30 minutes of heparin administration to prevent excessive bleeding or hemorrhage. Protamine sulfate should be given slowly intravenously to avoid adverse effects such as hypotension, bradycardia, pulmonary edema, and anaphylaxis.

Choice B is wrong because protamine sulfate should not be given rapidly or intramuscularly. Rapid administration can cause severe hypotension and shock, and intramuscular administration can cause local irritation and hematoma formation.

Choice C is wrong because protamine sulfate should not be given more than 60 minutes after heparin administration. The half-life of heparin is 60 to 90 minutes, and the anticoagulant effect of heparin will usually wear off within a few hours after discontinuation. Giving protamine sulfate after 60 minutes may cause excess anticoagulation or “heparin rebound” due to the longer half-life of protamine sulfate.

Choice D is wrong for the same reasons as choice B. Protamine sulfate should not be given rapidly or intramuscularly.

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Correct Answer is A

Explanation

Inject heparin at a 90-degree angle into the abdomen, at least 2 inches away from the umbilicus.This is the appropriate technique for administering subcutaneous heparin, as it ensures that the drug reaches the fat layer under the skin and reduces the risk of bleeding and bruising.

Choice B is wrong because heparin should not be injected into the deltoid muscle, as it may cause tissue damage and nerve injury.Heparin should also not be aspirated before injecting, as it may cause hematoma formation.

Choice C is wrong because heparin should not be injected at a 90-degree angle into the thigh, as it may cause pain and irritation.The thigh is also not a preferred site for heparin injection, as it has less fat tissue than the abdomen.

Choice D is wrong because heparin should not be injected at a 45-degree angle into the upper arm, as it may cause nerve damage and hematoma formation.Heparin should also not be massaged after injection, as it may increase the risk of bleeding and bruising.

A. “Warfarin, which is an oral anticoagulant that works by blocking vitamin K.” B. “Aspirin, which is an antiplatelet agent that works by inhibiting cyclooxygenase.” C. “Argatroban, which is a direct thrombin inhibitor that works by binding to thrombin.” D. “Streptokinase, which is a thrombolytic agent that works by converting plasminogen to plasmin.”

Correct Answer is C

Explanation

Argatroban, which is a direct thrombin inhibitor that works by binding to thrombin. This is because argatroban is an alternative anticoagulant that can be used for patients with HIT, as it does not cause platelet aggregation or activation. Argatroban directly inhibits thrombin, which is the enzyme that converts fibrinogen to fibrin and activates platelets.

Choice A is wrong because warfarin, which is an oral anticoagulant that works by blocking vitamin K, is contraindicated in patients with HIT, as it can cause skin necrosis and limb gangrene due to microvascular thrombosis.

Warfarin also has a delayed onset of action and requires monitoring of the international normalized ratio (INR).

Choice B is wrong because aspirin, which is an antiplatelet agent that works by inhibiting cyclooxygenase, is also contraindicated in patients with HIT, as it can increase the risk of bleeding and does not prevent thrombosis.

Aspirin also has a long-lasting effect on platelet function and can interact with other drugs.

Choice D is wrong because streptokinase, which is a thrombolytic agent that works by converting plasminogen to plasmin, is not indicated for patients with HIT, as it can cause severe bleeding complications and allergic reactions.

Streptokinase also has a short half-life and requires continuous infusion.

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A nurse is administering protamine sulfate to a client who has received an overdose of heparin. What are some important nursing considerations for this medication?

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Correct Answer is C

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A nurse is administering protamine sulfate to a client who has received an overdose of heparin. What are some important nursing considerations for this medication?