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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.

Answer and Explanation

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

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Correct Answer is B

Explanation

Argatroban is a direct thrombin inhibitor (DTI) that is used as an alternative anticoagulant for patients with heparin-induced thrombocytopenia (HIT) who require urgent surgery. Argatroban has a half-life of about 40 to 50 minutes and is cleared by the liver.The infusion should be stopped at least 4 hours before the surgery to allow adequate time for the anticoagulant effect to wear off.The activated partial thromboplastin time (aPTT) should be monitored before and after the infusion to assess the degree of anticoagulation.

Choice A is wrong because 2 hours is not enough time to stop the argatroban infusion before surgery.

The patient may still have a high risk of bleeding if the aPTT is prolonged.

Choice C is wrong because 6 hours is longer than necessary to stop the argatroban infusion before surgery.

The patient may have a higher risk of thrombosis if the anticoagulation effect is too low.

Choice D is wrong because 8 hours is much longer than necessary to stop the argatroban infusion before surgery.

The patient may have a very low level of anticoagulation and a high risk of thrombosis if the infusion is stopped for too long.

A. History of hypertension B. History of stroke C. History of peptic ulcer disease D. History of diabetes mellitus. E. Shortness of breath.

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.

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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: *.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is B

Explanation

The nurse recognizes what absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction?

Correct Answer is B

Explanation

A patient has been prescribed rivaroxaban (Xarelto) for deep vein thrombosis (DVT). Which statement by the patient indicates understanding of medication teaching?

Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all that apply:

A nurse is caring for a patient who has been prescribed enoxaparin (Lovenox) subcutaneously for prophylaxis against deep vein thrombosis (DVT). The nurse should instruct the patient to:

The patient has been receiving heparin therapy for deep vein thrombosis (DVT). The patient’s activated partial thromboplastin time (aPTT) result is 90 seconds (therapeutic range: 60-80 seconds). What will be included in patient care? (Select all that apply.).

A nurse is caring for a client who has atrial fibrillation and is receiving warfarin therapy to prevent thromboembolism formation. The nurse should monitor which of the following laboratory values to determine the effectiveness of the medication?

A nurse is caring for a client who has pulmonary embolism and is receiving alteplase via continuous IV infusion.The nurse should monitor for which adverse effects of this medication? (Select all that apply.)

A nurse is reviewing the medication list of a client who is prescribed dabigatran and has a history of peptic ulcer disease. The nurse should recognize that which of the following medications can increase the risk of bleeding in this client?