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","E"]

Explanation

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

A. 2 hours B. 4 hours C. 6 hours D. 8 hours.

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.

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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 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: *.

Correct Answer is ["B","E"]

Explanation

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

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