A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis?
Warfarin PO
Enoxaparin subcutaneous
Aspirin PO
Heparin infusion
The Correct Answer is B
Choice A reason: Warfarin PO is not a suitable medication for DVT prophylaxis in the immediate postoperative period, as it has a slow onset of action and requires frequent monitoring of the INR (international normalized ratio). Warfarin may be used for long-term anticoagulation, but it is not effective for preventing the formation of new clots.
Choice B reason: Enoxaparin subcutaneous is a suitable medication for DVT prophylaxis in the immediate postoperative period, as it has a rapid onset of action and does not require frequent monitoring of the coagulation status. Enoxaparin is a low-molecular-weight heparin that inhibits the formation of thrombin and prevents the growth of existing clots.
Choice C reason: Aspirin PO is not a suitable medication for DVT prophylaxis in the immediate postoperative period, as it has a weak anticoagulant effect and may increase the risk of bleeding. Aspirin is an antiplatelet agent that inhibits the aggregation of platelets and prevents the formation of arterial clots, but it is not effective for preventing venous clots.
Choice D reason: Heparin infusion is not a suitable medication for DVT prophylaxis in the immediate postoperative period, as it requires continuous intravenous administration and frequent monitoring of the aPTT (activated partial thromboplastin time). Heparin is an unfractionated heparin that inhibits the formation of thrombin and prevents the growth of existing clots, but it has a narrow therapeutic window and a high risk of bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Hematocrit 45% is not the correct data. Hematocrit is the percentage of red blood cells in the blood. The normal range for hematocrit is 37% to 47% for women and 42% to 52% for men. Hematocrit 45% is within the normal range and does not indicate any abnormality related to heparin therapy. Heparin does not affect the production or destruction of red blood cells.
Choice B reason: Platelets 74,000/mm3 is the correct data. Platelets are the blood cells that are responsible for clotting and preventing bleeding. The normal range for platelets is 150,000 to 400,000/mm3. Platelets 74,000/mm3 is below the normal range and indicates thrombocytopenia, which is a low platelet count. Thrombocytopenia is a serious complication of heparin therapy that can cause bleeding, bruising, and petechiae. The nurse should report this finding to the provider immediately and stop the heparin infusion.
Choice C reason: Partial thromboplastin time (PTT) 65 seconds is not the correct data. PTT is a blood test that measures the time it takes for the blood to clot. The normal range for PTT is 25 to 35 seconds. PTT 65 seconds is above the normal range and indicates that the blood is taking longer to clot. This is an expected effect of heparin therapy, as heparin is an anticoagulant that inhibits the formation of blood clots. The nurse should monitor the PTT and adjust the heparin dose according to the provider's orders and the protocol.
Choice D reason: White blood cell count 8,000/mm3 is not the correct data. White blood cells are the blood cells that are involved in the immune system and fight infections. The normal range for white blood cells is 4,500 to 11,000/mm3. White blood cell count 8,000/mm3 is within the normal range and does not indicate any abnormality related to heparin therapy. Heparin does not affect the production or function of white blood cells.
Correct Answer is D
Explanation
Choice A reason: Using IV tubing specific for heparin sodium when administering the infusion is not the correct action. Heparin sodium can be administered using any standard IV tubing, as long as it is primed with heparin solution to prevent clotting in the tubing.
Choice B reason: Administering 50,000 units of heparin by IV bolus every 12 hours is not the correct action. This is a very high dose of heparin that can cause bleeding complications. The usual dose of heparin for continuous IV infusion is 15 to 25 units/kg/hour, adjusted according to the aPTT results.
Choice C reason: Having vitamin K available on the nursing unit is not the correct action. Vitamin K is the antidote for warfarin, not heparin. Vitamin K reverses the effects of warfarin by increasing the synthesis of clotting factors in the liver.
Choice D reason: Checking the activated partial thromboplastin time (aPTT) every 4 hours is the correct action. The aPTT is a blood test that measures the time it takes for the blood to clot. It is used to monitor the effectiveness and safety of heparin therapy. The therapeutic range of aPTT for heparin is 1.5 to 2.5 times the normal value, or 60 to 80 seconds. The nurse should check the aPTT every 4 hours until it is within the therapeutic range, and then every 6 to 8 hours thereafter. The nurse should adjust the heparin infusion rate according to the aPTT results and the prescriber's orders.
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