A nurse is caring for a patient who is receiving heparin therapy via continuous IV infusion for treatment of deep vein thrombosis (DVT). The nurse should monitor which of the following laboratory values to evaluate therapeutic effectiveness of heparin therapy?

Activated partial thromboplastin time (aPTT)

Prothrombin time (PT)

International normalized ratio (INR)

Platelet count

Hemoglobin.

Answer and Explanation

The Correct Answer is A

The correct answer is choice A) Activated partial thromboplastin time (aPTT). This is because aPTT is the most commonly used laboratory test to monitor the therapeutic effect of heparin therapy.

Heparin is an anticoagulant that inhibits the formation of thrombin and fibrin, which are essential for blood clotting. Heparin therapy is indicated for the treatment of deep vein thrombosis (DVT), which is a condition where blood clots form in the deep veins of the legs or pelvis.

Choice B) Prothrombin time (PT) is wrong because PT is used to monitor the therapeutic effect of warfarin therapy, not heparin therapy.

Warfarin is another anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors. Warfarin therapy is also indicated for the treatment of DVT, but it has a different mechanism of action and monitoring than heparin therapy.

Choice C) International normalized ratio (INR) is wrong because INR is a standardized way of reporting PT results that accounts for the variability of different laboratory methods. INR is also used to monitor the therapeutic effect of warfarin therapy, not heparin therapy.

Choice D) Platelet count is wrong because platelet count is not directly affected by heparin therapy. However, platelet count should be monitored periodically in patients receiving heparin therapy to detect heparin-induced thrombocytopenia (HIT), which is a rare but serious complication of heparin therapy that causes a drop in platelet count and an increased risk of thrombosis.

Choice E) Hemoglobin is wrong because hemoglobin is not directly affected by heparin therapy. However, hemoglobin should be monitored periodically in patients receiving heparin therapy to detect bleeding complications, which are the most common adverse effects of heparin therapy.

The normal range for aPTT is 25 to 35 seconds, but the therapeutic range for heparin therapy is usually 1.5 to 2.5 times the normal range, depending on the indication and protocol.

The normal range for PT is 11 to 13 seconds, and the therapeutic range for warfarin therapy is usually an INR of 2 to 3, depending on the indication and protocol

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

Explanation

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.

A. Unusual bleeding or bruising B. Blood in urine or stool C. Abdominal pain or swelling D. Headache or dizziness E. Shortness of breath.

Correct Answer is ["A","B","C"]

Explanation

Dabigatran etexilate mesylate (Pradaxa) is a medication that prevents blood clots and reduces the risk of stroke in patients with atrial fibrillation.

However, it can also cause bleeding as a side effect.

Therefore, the nurse should instruct the client to report any signs of unusual bleeding or bruising, blood in urine or stool, or abdominal pain or swelling immediately.These could indicate a serious complication such as gastrointestinal bleeding, hemorrhage, or internal organ damage.

Choice D, headache or dizziness, is not a correct answer.

Although these symptoms could be caused by dabigatran, they are not as serious or urgent as bleeding.

They could also be due to other factors such as dehydration, low blood pressure, or stress.The nurse should advise the client to monitor these symptoms and seek medical attention if they persist or worsen.

Choice E, shortness of breath, is not a correct answer.

Shortness of breath is not a common side effect of dabigatran.

However, it could be a symptom of atrial fibrillation or its complications such as heart failure or stroke.The nurse should educate the client about the signs and symptoms of these conditions and instruct them to call 911 if they experience chest pain, palpitations, fainting, or weakness.

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A nurse is caring for a patient who is receiving heparin therapy via continuous IV infusion for treatment of deep vein thrombosis (DVT). The nurse should monitor which of the following laboratory values to evaluate therapeutic effectiveness of heparin therapy?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

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

Explanation

A client who has atrial fibrillation is prescribed dabigatran etexilate mesylate (Pradaxa). The nurse should instruct the client to report which of the following findings immediately? (Select all that apply.)

Correct Answer is ["A","B","C"]

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?

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?

A patient who has atrial fibrillation is taking warfarin and has an INR of 2.5.The patient reports having frequent headaches and asks for an over-the-counter pain reliever.The nurse will recommend which medication?

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 patient who has been prescribed apixaban (Eliquis) for deep vein thrombosis (DVT). Which instructions should be included in patient teaching? Select all that apply.

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 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 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: *.