A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure what information is gathered correctly before initiating the drip? Select all that apply: *.
Vital signs
Weight
PT/INR level
EKG
aPTT level.
Correct Answer : B,E
The nurse would need to know the patient’s weight and aPTT level before starting the IV continuous Heparin drip.
Here is why:
• Weight: Heparin dosing is based on the patient’s weight, so the nurse would want to make sure the documented weight of the patient is current and accurate. The initial bolus and infusion rate are calculated using the patient’s weight in kilograms.
• aPTT: Heparin works by enhancing the activation of antithrombin III, which prevents the activation of thrombin and the conversion of fibrinogen to fibrin. Heparin affects the intrinsic pathway of clotting, and its therapeutic effect is monitored by measuring the activated partial thromboplastin time (aPTT). The normal range for aPTT is about 30-40 seconds, and the therapeutic range for Heparin is 1.5-2.5 times the normal value. The nurse would need to check the baseline aPTT before starting the drip, and then collect an aPTT level every 6 hours per protocol to adjust the infusion rate as needed.
The other choices are wrong because:
• Vital signs: Although vital signs are important to monitor for any patient, they are not specific to Heparin therapy. Heparin does not affect blood pressure, heart rate, respiratory rate, or temperature directly.
• PT/INR: These are coagulation tests that measure the extrinsic pathway of clotting, which is affected by Vitamin K antagonists such as Warfarin. Heparin does not affect the PT/INR levels, so they are not relevant for Heparin therapy.
• EKG: An electrocardiogram (EKG) is a test that measures the electrical activity of the heart. It can help diagnose cardiac arrhythmias, ischemia, infarction, electrolyte imbalances, and other cardiac conditions.
Heparin does not affect the electrical conduction of the heart, so an EKG is not necessary before starting Heparin therapy
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A history of stroke is an absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction (AMI).This is because thrombolytics can increase the risk of intracranial hemorrhage and worsen the neurological outcome.
Choice A is wrong because history of hypertension is not an absolute contraindication, but a relative one.This means that the benefits of thrombolytic therapy may outweigh the risks in some cases, depending on the severity and duration of hypertension.
Choice C is wrong because history of peptic ulcer disease is also a relative contraindication, not an absolute one.Thrombolytics can increase the risk of gastrointestinal bleeding, but this can be managed with proton pump inhibitors or histamine-2 blockers.
Choice D is wrong because history of diabetes mellitus is not a contraindication at all to thrombolytic therapy.In fact, some studies have shown that diabetic patients with AMI may benefit more from thrombolytic therapy than non-diabetic patients.
Correct Answer is ["C","E"]
Explanation
Verapamil is a calcium channel blocker that is used to treat variant angina by dilating the coronary arteries and relieving the chest pain caused by spasms.It also reduces blood pressure and heart rate, but these are not the expected outcomes for variant angina.
Choice A is wrong because verapamil decreases heart rate, not increases it.This can help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.
Choice B is wrong because verapamil decreases contractility, not increases it.This can also help reduce the oxygen demand of the heart, but it is not the main goal of therapy for variant angina.
Choice D is wrong because verapamil reduces blood pressure, not increases it.This can help lower the workload of the heart, but it is not the main goal of therapy for variant angina.
Normal ranges for heart rate are 60 to 100 beats per minute, for blood pressure are 120/80 mm Hg or lower, and for contractility are measured by ejection fraction, which is normally 55% or higher.
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