A nurse is assessing a client who has a history of deep vein thrombosis (DVT).

Which of the following findings should the nurse report to the provider?

The correct answer is choice B. Activated partial thromboplastin time (aPTT) of 60 seconds.This value indicates a therapeutic effect of heparin because it is about two times the normal value of 25 to 35 seconds.Heparin produces its major anticoagulant effect by inactivating thrombin and factor Xa through an antithrombin-dependent mechanism.The APTT measures the intrinsic and common pathways of coagulation, which are affected by heparin.

Choice A is wrong because platelet count of 150,000/mm3 is within the normal range of 150,000 to 450,000/mm3.Heparin does not affect platelet count directly, but it can cause heparin-induced thrombocytopenia, a serious complication that reduces platelet count and increases the risk of thrombosis.

Choice C is wrong because prothrombin time (PT) of 12 seconds is within the normal range of 11 to 13.5 seconds.Heparin does not affect PT significantly because PT measures the extrinsic and common pathways of coagulation, which are not affected by heparin.

Choice D is wrong because international normalized ratio (INR) of 1.0 is within the normal range of 0.8 to 1.2.Heparin does not affect INR significantly because INR is a standardized measure of PT that reflects the activity of vitamin K-dependent factors, which are not affected by heparin.

The correct answer is A. How to administer LMWH subcutaneously.LMWH is a class of anticoagulant medications that are used to prevent and treat blood clots, such as DVT and PELMWH can be given subcutaneously and does not require frequent blood tests to monitor coagulation, unlike unfractionated heparinTherefore, the nurse should teach the client how to inject LMWH into the fatty tissue under the skin, usually in the abdomen or thigh, using a prefilled syringe.

B. The need for frequent blood tests to monitor coagulation.This statement is wrong because LMWH has more predictable pharmacokinetics and anticoagulant effect than unfractionated heparin, and does not require routine monitoring of APTT or anti-factor Xa levelsHowever, some patients may need monitoring in special situations, such as extremes of weight, renal impairment, or pregnancy.

C. The signs and symptoms of heparin-induced thrombocytopenia (HIT).This statement is wrong because HIT is a rare but serious complication of heparin therapy that causes a drop in platelet count and an increased risk of thrombosisHIT is more common with unfractionated heparin than with LMWH, but it can still occur with LMWH in some casesTherefore, the nurse should inform the client about the signs and symptoms of HIT, such as fever, chills, rash, bleeding, bruising, or new or worsening clots, and advise them to seek medical attention if they occur.

D. The antidote for LMWH in case of overdose.This statement is wrong because there is no specific antidote for LMWH in case of overdose or bleeding complicationsUnlike unfractionated heparin, which can be reversed with protamine sulfate, LMWH has only partial reversal with protamine sulfate and may require other measures such as transfusion of blood products or use of recombinant factor VIIaTherefore, the nurse should instruct the client to follow the prescribed dose and schedule of LMWH and to report any signs of bleeding or overdose, such as nosebleeds, gum bleeding, blood in urine or stool, or excessive bruising.