A nurse is caring for a client who is receiving argatroban IV for HIT and requires urgent surgery. The nurse should stop the infusion at least how many hours before the surgery?

The correct answer is choice D) Use a soft-bristled toothbrush.

This is because enoxaparin (Lovenox) is an anticoagulant that prevents blood clots by thinning the blood.Therefore, patients who take enoxaparin should avoid activities that can cause bleeding, such as using a hard-bristled toothbrush, flossing, shaving, or cutting their nails.

Choice A) Avoid foods that are high in vitamin K is wrong because vitamin K interacts with warfarin, another anticoagulant, but not with enoxaparin.Vitamin K helps the blood clot, so patients who take warfarin should avoid foods that are high in vitamin K, such as leafy green vegetables, broccoli, or liver.

Choice B) Administer injections into areas with decreased subcutaneous tissue is wrong because enoxaparin should be injected into areas with adequate subcutaneous tissue, such as the abdomen or the thighs.Injecting into areas with decreased subcutaneous tissue can cause bruising, pain, or hematoma formation.

Choice C) Massage injection sites after administration is wrong because massaging the injection sites can cause bleeding, bruising, or irritation.Patients who take enoxaparin should not rub or press on the injection sites after administration.

Heparin is an anticoagulant that inhibits blood clotting and prevents harmful clots from forming in blood vessels.However, heparin can also cause some serious side effects, such as bleeding, bruising, low platelet count, allergic reactions, and osteoporosis.

Therefore, patients who are at a high risk for developing these adverse effects should be monitored closely and have their heparin dose adjusted accordingly.

Choice A is correct because a patient who is post-op day 1 from brain surgery has a high risk of bleeding from the surgical site or intracranially.Heparin can increase this risk and cause life-threatening hemorrhage.

Therefore, this patient should not receive heparin unless absolutely necessary and under strict supervision.

Choice B is wrong because a patient with a pulmonary embolism (PE) is a candidate for heparin therapy.

A PE is a blood clot that blocks the blood flow to the lungs and can cause respiratory failure and death.Heparin can prevent the clot from becoming larger and causing more damage, and also prevent new clots from forming.

Therefore, this patient would benefit from heparin therapy and is not at a high risk of adverse effects.

Choice C is correct because a patient with active peptic ulcer disease (PUD) has a high risk of bleeding from the stomach or duodenum.

PUD is a condition where the lining of the digestive tract is eroded by stomach acid and bacteria.Heparin can worsen this condition and cause ulcer bleeding or perforation.

Therefore, this patient should avoid heparin therapy unless absolutely necessary and under strict supervision.

Choice D is wrong because a patient with uncontrolled atrial fibrillation (AF) is a candidate for heparin therapy.

AF is an irregular heartbeat that can cause blood clots to form in the heart chambers and travel to other organs, such as the brain or lungs.Heparin can prevent these clots from forming and reduce the risk of stroke or PE.

Therefore, this patient would benefit from heparin therapy and is not at a high risk of adverse effects.

Normal ranges of heparin depend on the type of heparin used (unfractionated heparin or low molecular weight heparin), the method of administration (intravenous or subcutaneous), and the indication for use (prophylaxis or treatment).Generally, the therapeutic range for heparin level is 0.3 - 0.7 U/mL, measured by anti-Xa assay.However, this range may vary depending on the pregnancy stage and the type of heparin used.The dose of heparin should be individualized according to the results of suitable laboratory tests and clinical response.