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

A 55-year-old male patient who is post-op day 1 from brain surgery.

A 45-year-old female patient with a pulmonary embolism.

A 36-year-old male patient with active peptic ulcer disease.

A 43-year-old female with uncontrolled atrial fibrillation.

Answer and Explanation

Correct Answer : A,C

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.

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Correct Answer is ["B"]

Explanation

Alteplase is a fibrinolytic agent that dissolves blood clots and restores blood flow.However, it also increases the risk of bleeding from any site, such as the nose, gums, injection sites, or internal organs.Therefore, the nurse should monitor the client for signs of bleeding, such as bruising, hematuria, hematemesis, melena, or decreased hemoglobin and hematocrit levels.

Choice A is wrong because hypotension is not a common adverse effect of alteplase.Hypotension may occur due to blood loss from bleeding or other causes, such as dehydration, sepsis, or cardiac dysfunction.

Choice C is wrong because dysrhythmias are not a common adverse effect of alteplase.Dysrhythmias may occur due to pulmonary embolism itself, which can cause hypoxia, acidosis, and increased pulmonary artery pressure.

Choice D is wrong because nausea is not a common adverse effect of alteplase.Nausea may occur due to other factors, such as anxiety, pain, or medications.

Choice E is wrong because fever is not a common adverse effect of alteplase.Fever may occur due to infection, inflammation, or other causes.

A. Assessing for signs and symptoms of bleeding B. Continuing heparin therapy at current rate C. Decreasing heparin therapy per protocol D. Holding heparin therapy per protocol E. Increasing heparin therapy per protocol.

Correct Answer is ["A","D"]

Explanation

A patient with a high aPTT result is at risk for bleeding, so assessing for signs and symptoms of bleeding is important.

Holding heparin therapy per protocol is also appropriate, as heparin is the cause of the prolonged aPTT.

The other choices are wrong because:

• Choice B is wrong because continuing heparin therapy at the current rate will increase the risk of bleeding and further prolong the aPTT.

• Choice C is wrong because decreasing heparin therapy per protocol is not enough to reverse the effects of heparin.

Heparin should be stopped until the aPTT returns to the therapeutic range.

• Choice E is wrong because increasing heparin therapy per protocol will worsen the situation and cause more bleeding and coagulation problems.

The normal range for aPTT is 25 to 35 seconds, and the therapeutic range for heparin therapy is 60 to 80 seconds.A result of 90 seconds indicates excessive anticoagulation and increased bleeding risk.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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.)

Correct Answer is ["B"]

Explanation

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.).

Correct Answer is ["A","D"]

Explanation

A patient is receiving heparin therapy during hemodialysis for chronic renal failure and develops heparin-induced thrombocytopenia (HIT). The nurse anticipates that which medication will be ordered for this patient?

A nurse is teaching a client who has a new prescription for bivalirudin about potential adverse effects of the drug. Which of the following effects should the nurse include? (Select all that apply.)

A nurse is caring for a client who has variant angina and is prescribed verapamil. Which of the following are expected outcomes of this medication? (Select all that apply.)

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: *.

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 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?

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 nurse is caring for a patient who has received alteplase [Activase]. It is most important for the nurse to take which action?