A nurse is caring for a client who has a thrombus and is receiving a continuous infusion of heparin. The client asks the nurse how long it will take for the heparin to dissolve the clot.
Which of the following responses should the nurse make?
"The time it takes for heparin to dissolve a clot depends on the size of the clot.".
"The time it takes for heparin to dissolve a clot varies between clients.".
"Usually, it takes at least 2 to 3 days for heparin to dissolve a clot.".
"Heparin prevents new clots from forming rather than dissolving existing ones.".
The Correct Answer is D
Heparin is an anticoagulant that is used to decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels 1.
However, heparin will not dissolve blood clots that have already formed, but it may prevent the clots from becoming larger and causing more serious problems 12.
Choices A, B, and C are incorrect because heparin does not dissolve existing clots. Instead, it works to prevent new clots from forming 12.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The nurse should instruct the client to cleanse the skin before applying a nitroglycerin transdermal patch 1.
This is because it is important to apply the patch to a clean, dry skin area with little or no hair that is free of scars, cuts, or irritation 1.
Choice A is incorrect because it is not recommended to use an old patch with medication residue.
Instead, always remove a previous patch before applying a new one 1.
Choice B is incorrect because a nitroglycerin patch should not be kept in place for 72 hours before replacing.
Instead, it should be worn for 12 to 14 hours and then removed 2.
Choice C is incorrect because the patch should not be applied to a hairy area of the skin for better adherence.
Instead, it should be applied to an area with little or no hair 1.
Correct Answer is A
Explanation
“Inject air into the regular insulin first.” When mixing regular insulin and NPH insulin in the same syringe, the nurse should instruct the client to inject air into the NPH insulin vial first, then inject air into the regular insulin vial.
After that, the client should draw up the regular insulin into the syringe first, followed by the NPH insulin.
Choice B is not correct because NPH insulin should not be shaken vigorously as it can damage the insulin molecules.
Choice C is not correct because the regular insulin should be drawn up into the syringe first.
Choice D is not correct because regular insulin is a clear solution and should not appear cloudy.
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