A patient who has been receiving IV heparin infusion and oral warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when the platelet level drops to 80,000/uL. Which action will the nurse take first?
Ask the HCP to change the medication from heparin to enoxaparin (Lovenox).
Discontinuing the heparin infusion
Administering prescribed warfarin (Coumadin)
Preparing for platelet transfusion
The Correct Answer is B
Choice A reason: Asking the HCP to change the medication from heparin to enoxaparin (Lovenox) would not be the most appropriate action for a patient diagnosed with heparin-induced thrombocytopenia (HIT). Enoxaparin, like heparin, is a low molecular weight heparin and can still cause HIT. Therefore, this action does not address the immediate need to stop the heparin infusion to prevent further reduction in platelet levels and manage the HIT effectively.
Choice B reason: Discontinuing the heparin infusion is the correct action for a nurse to take first when a patient is diagnosed with heparin-induced thrombocytopenia (HIT). The primary step in managing HIT is to stop all forms of heparin to prevent further platelet activation and decrease in platelet count. Discontinuing heparin helps to prevent thromboembolic complications associated with HIT. Once heparin is discontinued, the healthcare provider can evaluate alternative anticoagulation therapies that do not cross-react with heparin, such as direct thrombin inhibitors.
Choice C reason: Administering prescribed warfarin (Coumadin) is not appropriate at this stage for a patient diagnosed with heparin-induced thrombocytopenia (HIT). Warfarin can initially lead to a hypercoagulable state, which increases the risk of thrombosis in patients with HIT. The immediate priority is to discontinue heparin, and warfarin should only be considered once platelet counts have recovered and the acute HIT has been managed.
Choice D reason: Preparing for platelet transfusion is not the first action to take for managing heparin-induced thrombocytopenia (HIT). Platelet transfusions are generally avoided in HIT as they can potentially worsen the thrombotic risk. The primary action should be to discontinue heparin and consider alternative anticoagulation therapies. Platelet transfusions may be reserved for cases where there is significant bleeding or invasive procedures are planned.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E","F"]
Explanation
Choice A reason: Applying a clean, dry dressing over the VTE/DVT site is not necessary. VTE/DVT usually involves deep veins where there are no visible wounds requiring dressings. This instruction is irrelevant to the management and discharge instructions for a patient with DVT on anticoagulant therapy.
Choice B reason: Monitoring activated partial thromboplastin time (aPTT) results is relevant for heparin therapy, not for warfarin. Warfarin therapy is monitored using the international normalized ratio (INR). Therefore, this instruction is not appropriate for a patient being discharged on warfarin.
Choice C reason: Administering the warfarin dose at the same time each day is crucial for maintaining consistent blood levels of the medication, ensuring its effectiveness. It helps to maintain steady anticoagulation and reduces the risk of complications associated with fluctuating blood levels of warfarin.
Choice D reason: Instructing the patient to take aspirin or NSAIDs as needed for pain is inappropriate because these medications can increase the risk of bleeding when taken with warfarin. Patients on warfarin should avoid these medications and use alternatives like acetaminophen (Tylenol) for pain relief.
Choice E reason: Advising the patient to use electric razors, not straight razors, when shaving is important to prevent cuts and bleeding. Warfarin increases the risk of bleeding, and using an electric razor minimizes the chance of nicks and cuts that could lead to significant bleeding.
Choice F reason: Monitoring the level of anticoagulation with warfarin using INR results is essential. Regular INR monitoring ensures that the patient maintains a therapeutic level of anticoagulation and helps prevent both clotting and bleeding complications. Adjustments to the warfarin dose are made based on INR results.
Correct Answer is B
Explanation
Choice A reason:
Receiving a blood transfusion after 1992 does not strongly indicate the need for hepatitis C screening because screening of blood products for hepatitis C became standard practice in the early 1990s. By 2005, the risk of transmission via transfusion had been effectively eliminated. Therefore, while a past transfusion may be part of the patient's health history, it does not necessitate hepatitis C screening in this case.
Choice B reason:
Intravenous drug use, even if it occurred 20 years ago, is a significant risk factor for hepatitis C infection. The virus is commonly transmitted through the sharing of needles or other equipment used to inject drugs. Due to the long latency period of hepatitis C, individuals with a history of IV drug use are at high risk and should be screened regardless of how long ago the exposure occurred. This is the most relevant information in the patient’s history to prompt screening.
Choice C reason:
Frequent dining in fast-food restaurants does not indicate a risk for hepatitis C. Hepatitis C is primarily spread through blood-to-blood contact, not through food or drink. This choice reflects a misunderstanding of the transmission pathways of hepatitis C and is irrelevant to the patient’s screening needs.
Choice D reason:
Traveling to a country with poor sanitation is more associated with the risk of hepatitis A, a virus that is often spread through contaminated water or food. Hepatitis C, however, is not typically transmitted via poor sanitation or contaminated food and water. Screening for hepatitis C would not be warranted based solely on travel history to such countries.
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