A nurse is caring for a client who develops heparin-induced thrombocytopenia (HIT) while receiving unfractionated heparin for pulmonary embolism. The nurse anticipates that the health care provider will order which of the following medications to treat this condition?
“Warfarin, which is an oral anticoagulant that works by blocking vitamin K.”
“Aspirin, which is an antiplatelet agent that works by inhibiting cyclooxygenase.”
“Argatroban, which is a direct thrombin inhibitor that works by binding to thrombin.”
“Streptokinase, which is a thrombolytic agent that works by converting plasminogen to plasmin.”
The Correct Answer is C
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
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.
Correct Answer is ["A","B","C"]
Explanation
A. Stop the heparin infusion immediately.This is correctbecause heparin is an anticoagulant that prevents blood clotting by inhibiting the formation of thrombin.
The activated partial thromboplastin time (aPTT) is a test that measures how long it takes for the blood to clot.
The normal range for aPTT is25 to 35 seconds.
A high aPTT indicates that the blood is taking too long to clot, which increases the risk of bleeding.
Therefore, the heparin infusion should be stopped to prevent further bleeding.
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B. Administer protamine sulfate as ordered.This is correctbecause protamine sulfate is an antidote for heparin overdose.
It binds to heparin and neutralizes its anticoagulant effect.
Protamine sulfate should be administered as ordered by the health care provider to reverse the heparin overdose and restore normal clotting time.
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C. Notify the health care provider of the result.This is correctbecause the health care provider should be informed of the abnormal aPTT result and the actions taken by the nurse.
The health care provider may order further tests or adjust the heparin dosage or frequency based on the client’s condition and response to treatment.
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D. Draw a prothrombin time (PT) and international normalized ratio (INR) level.This is wrongbecause PT and INR are tests that measure the effect of warfarin, another anticoagulant, on blood clotting.
They are not affected by heparin and are not relevant for this client.
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E. Monitor the client for signs and symptoms of bleeding.This is wrongbecause this is not an appropriate action in this situation.
The nurse should not wait for signs and symptoms of bleeding to occur, but should act immediately to stop the heparin infusion, administer protamine sulfate, and notify the health care provider.
Monitoring for bleeding is a preventive measure that should be done before and during heparin therapy, not after an overdose has occurred.
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