The nurse knows that which drug should be readily available in case a patient experiences a heparin overdose?

A. Continue heparin therapy and monitor platelet counts: Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction in which antibodies form against the heparin–platelet factor 4 complex, leading to platelet activation and thrombosis. Continuing heparin can worsen platelet consumption and increase the risk of life-threatening thromboembolic events.

B. Discontinue heparin immediately and start an alternative anticoagulant: The priority intervention in suspected HIT is the immediate cessation of all heparin products to prevent further antibody-mediated platelet activation. Because HIT creates a prothrombotic state, an alternative non-heparin anticoagulant is initiated to reduce the risk of DVT or PE.

C. Administer platelet transfusion to manage thrombocytopenia: In HIT, thrombocytopenia results from platelet activation and consumption, not from decreased production. Transfusing platelets may exacerbate thrombosis by providing additional substrate for clot formation. Platelet transfusions are generally avoided unless there is significant active bleeding.

D. Administer intravenous fluids to prevent dehydration: While maintaining adequate hydration is important for overall circulatory stability, IV fluids do not address the immune-mediated platelet activation or thrombotic risk associated with HIT. The immediate threat is thrombosis, which requires stopping heparin and initiating alternative anticoagulation.

A. Increase the patient's head of bed to 30 degrees: Elevating the head of the bed is a standard measure to promote venous drainage and help prevent further increases in ICP. However, this intervention is preventive and supportive and may not provide immediate reduction in ICP once it has acutely risen to 22 mmHg.

B. Administer an osmotic diuretic as ordered: Osmotic diuretics, such as mannitol, draw fluid from brain tissue into the intravascular space, rapidly reducing cerebral edema and lowering ICP. Immediate administration is critical when ICP exceeds normal limits (typically >20 mmHg) to prevent secondary brain injury from decreased cerebral perfusion and herniation.

C. Administer high-dose corticosteroids to reduce brain swelling: Corticosteroids are not routinely indicated for ICP management in acute traumatic brain injury; they are primarily used in vasogenic edema associated with brain tumors or specific inflammatory conditions. They do not act rapidly enough to address acute elevations in ICP.

D. Administer pain medications to relieve discomfort: While pain control is important to prevent sympathetic stimulation that can elevate ICP, analgesics alone do not rapidly lower ICP. Immediate reduction of dangerously high ICP requires interventions that directly decrease cerebral edema or volume, such as osmotic diuretics.