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

A history of stroke is an absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction (AMI).This is because thrombolytics can increase the risk of intracranial hemorrhage and worsen the neurological outcome.

Choice A is wrong because history of hypertension is not an absolute contraindication, but a relative one.This means that the benefits of thrombolytic therapy may outweigh the risks in some cases, depending on the severity and duration of hypertension.

Choice C is wrong because history of peptic ulcer disease is also a relative contraindication, not an absolute one.Thrombolytics can increase the risk of gastrointestinal bleeding, but this can be managed with proton pump inhibitors or histamine-2 blockers.

Choice D is wrong because history of diabetes mellitus is not a contraindication at all to thrombolytic therapy.In fact, some studies have shown that diabetic patients with AMI may benefit more from thrombolytic therapy than non-diabetic patients.

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

The nurse recognizes what absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction?

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

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

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: *.

A nurse is caring for a client who has atrial fibrillation and is receiving warfarin therapy to prevent thromboembolism formation. The nurse should monitor which of the following laboratory values to determine the effectiveness of the medication?

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 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 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.)