Heparin Infusion Review.
A nurse is reviewing the laboratory results of a client who is receiving heparin by continuous IV infusion.
Which of the following results indicates the nurse should decrease the infusion rate?
Erythrocyte sedimentation rate 18 mm/hr.
aPTT 90 seconds.
INR.2.
Platelets 350,000/mm.
The Correct Answer is B
Heparin is an anticoagulant medication that is used to decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels.
The activated partial thromboplastin time (aPTT) is a laboratory test commonly used to monitor unfractionated heparin therapy.
An aPTT value of 90 seconds is above the therapeutic range and indicates that the heparin infusion rate should be decreased.
Choice A is wrong because Erythrocyte sedimentation rate 18 mm/hr, is not the correct answer because it is not used to monitor heparin therapy.
Choice C is wrong because INR.2, is not the correct answer because it falls within the normal range for INR values and is not used to monitor heparin therapy.
Choice D is wrong because Platelets 350,000/mm, is not the correct answer because it falls within the normal range for platelet counts and is not used to monitor heparin therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The nurse should instruct the client to monitor and report bruising as an adverse effect of taking clopidogrel.
Clopidogrel increases the risk of bleeding, which can be severe or life- threatening.
Choice A is wrong because blurred vision is not a common adverse effect of clopidogrel.
Choice B is wrong because constipation is not a common adverse effect of clopidogrel.
Choice C is wrong because weight loss is not a common adverse effect of clopidogrel.
Correct Answer is C
Explanation
The correct answer is Choice C.
Choice A rationale:
- This response is not appropriate because it is judgmental and may make the client feel defensive.
- It is important for the nurse to respect the client's right to make their own decisions about their health care.
- Telling the client what they should do can undermine their autonomy and potentially damage the nurse-client relationship.
- It's crucial for the nurse to remain objective and avoid imposing their personal opinions or beliefs onto the client.
Choice B rationale:
- This response is also not appropriate because it is using scare tactics to try to persuade the client to get the vaccine.
- This approach can be counterproductive and may further alienate the client.
- It's important to provide accurate information about the risks and benefits of the vaccine in a neutral and non-threatening manner.
Choice C rationale:
- This is the most appropriate response because it acknowledges the client's right to refuse the vaccine while still encouraging them to get it.
- It also demonstrates respect for the client's autonomy and validates their feelings.
- This approach is more likely to foster a positive nurse-client relationship and keep the door open for future discussions about vaccination.
Choice D rationale:
- This response is not accurate because the influenza vaccine is not mandatory for all clients before discharge.
- It is important for the nurse to provide accurate information to the client.
- Threatening the client with an against medical advice form is not appropriate and may be considered a form of coercion.
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