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.”

Answer and Explanation

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.

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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.

A. “LMWH has a lower risk of bleeding than regular heparin.” B. “LMWH does not require frequent blood tests like regular heparin.” C. “LMWH has a more predictable effect than regular heparin.” D. All of the above.

Correct Answer is D

Explanation

Low molecular weight heparin (LMWH) is a type of anticoagulant medication that prevents blood clots.

LMWH has several advantages over regular heparin, such as:

• LMWH has a lower risk of bleeding than regular heparin.LMWH has a more specific action on the clotting factors and less effect on platelets, which reduces the risk of bleeding complications.

• LMWH does not require frequent blood tests like regular heparin.LMWH has a more predictable and consistent effect than regular heparin, which means that the dose does not need to be adjusted based on blood tests.Regular heparin requires frequent monitoring of the activated partial thromboplastin time (aPTT) to ensure therapeutic levels.

• LMWH has a more predictable effect than regular heparin.LMWH has a longer half-life and a higher bioavailability than regular heparin, which means that it works more reliably and lasts longer in the body.Regular heparin has a variable response and can be affected by factors such as age, weight, and renal function.

Therefore, the nurse should explain to the client that LMWH is a safer and more convenient option than regular heparin for home use.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

A nurse is educating a client who is prescribed low molecular weight heparin (LMWH) for home use. The client asks, “What is the difference between LMWH and regular heparin?” What is an appropriate response by the nurse?

Correct Answer is D

Explanation

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?

A nurse is reviewing the laboratory results of a client who is receiving intravenous unfractionated heparin. The nurse notes that the client’s activated partial thromboplastin time (aPTT) is 120 seconds. What are the appropriate nursing actions in this situation? Select all that apply.

A nurse is preparing to administer subcutaneous heparin to a client with deep vein thrombosis. What is the appropriate technique for this procedure?