Review Heparins

Anticoagulants and Thrombolytic Agents > Pharmacology

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Heparins

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Total Questions : 5

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Question 1:

A nurse is preparing to administer subcutaneous heparin to a client with deep vein thrombosis. What is the appropriate technique for this procedure?

A. Inject heparin at a 90-degree angle into the abdomen, at least 2 inches away from the umbilicus. B. Inject heparin at a 45-degree angle into the deltoid muscle, aspirating before injecting. C. Inject heparin at a 90-degree angle into the thigh, rotating sites between left and right legs. D. Inject heparin at a 45-degree angle into the upper arm, massaging the site after injection.

Answer and Explanation

Choice A:

Inject heparin at a 90-degree angle into the abdomen, at least 2 inches away from the umbilicus. This is the appropriate technique for administering subcutaneous heparin, as it ensures that the drug reaches the fat layer under the skin and reduces the risk of bleeding and bruising.

Choice B:

Choice B is wrong because heparin should not be injected into the deltoid muscle, as it may cause tissue damage and nerve injury. Heparin should also not be aspirated before injecting, as it may cause hematoma formation.

Choice C:

Choice C is wrong because heparin should not be injected at a 90-degree angle into the thigh, as it may cause pain and irritation. The thigh is also not a preferred site for heparin injection, as it has less fat tissue than the abdomen.

Choice D:

Choice D is wrong because heparin should not be injected at a 45-degree angle into the upper arm, as it may cause nerve damage and hematoma formation. Heparin should also not be massaged after injection, as it may increase the risk of bleeding and bruising.

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Question 2:

A nurse is reviewing the laboratory results of a client who is receiving intravenous unfractionated heparin. The nurse notes that the client’s activated partial thromboplastin time (aPTT) is 120 seconds. What are the appropriate nursing actions in this situation? Select all that apply.

A. Stop the heparin infusion immediately. B. Administer protamine sulfate as ordered. C. Notify the health care provider of the result. D. Draw a prothrombin time (PT) and international normalized ratio (INR) level. E. Monitor the client for signs and symptoms of bleeding.

Answer and Explanation

Choice A:

This is correctbecause heparin is an anticoagulant that prevents blood clotting by inhibiting the formation of thrombin.

The activated partial thromboplastin time (aPTT) is a test that measures how long it takes for the blood to clot.

The normal range for aPTT is25 to 35 seconds.

A high aPTT indicates that the blood is taking too long to clot, which increases the risk of bleeding.

Therefore, the heparin infusion should be stopped to prevent further bleeding.

Choice B:

This is correctbecause protamine sulfate is an antidote for heparin overdose.

It binds to heparin and neutralizes its anticoagulant effect.

Protamine sulfate should be administered as ordered by the health care provider to reverse the heparin overdose and restore normal clotting time.

Choice C:

This is correctbecause the health care provider should be informed of the abnormal aPTT result and the actions taken by the nurse.

The health care provider may order further tests or adjust the heparin dosage or frequency based on the client’s condition and response to treatment.

Choice D:

This is wrongbecause PT and INR are tests that measure the effect of warfarin, another anticoagulant, on blood clotting.

They are not affected by heparin and are not relevant for this client.

Choice E:

This is wrongbecause this is not an appropriate action in this situation.

The nurse should not wait for signs and symptoms of bleeding to occur, but should act immediately to stop the heparin infusion, administer protamine sulfate, and notify the health care provider.

Monitoring for bleeding is a preventive measure that should be done before and during heparin therapy, not after an overdose has occurred.

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Question 3:

A nurse is educating a client who is prescribed low molecular weight heparin (LMWH) for home use. The client asks, “What is the difference between LMWH and regular heparin?” What is an appropriate response by the nurse?

A. “LMWH has a lower risk of bleeding than regular heparin.” B. “LMWH does not require frequent blood tests like regular heparin.” C. “LMWH has a more predictable effect than regular heparin.” D. All of the above.

Answer and Explanation

Choice A:

LMWH has a more specific action on the clotting factors and less effect on platelets, which reduces the risk of bleeding complications.

Choice B:

LMWH has a more predictable and consistent effect than regular heparin, which means that the dose does not need to be adjusted based on blood tests.Regular heparin requires frequent monitoring of the activated partial thromboplastin time (aPTT) to ensure therapeutic levels.

Choice C:

LMWH has a longer half-life and a higher bioavailability than regular heparin, which means that it works more reliably and lasts longer in the body.Regular heparin has a variable response and can be affected by factors such as age, weight, and renal function.

Therefore, the nurse should explain to the client that LMWH is a safer and more convenient option than regular heparin for home use.

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Question 4:

A nurse is caring for a client who develops heparin-induced thrombocytopenia (HIT) while receiving unfractionated heparin for pulmonary embolism. The nurse anticipates that the health care provider will order which of the following medications to treat this condition?

A. “Warfarin, which is an oral anticoagulant that works by blocking vitamin K.” B. “Aspirin, which is an antiplatelet agent that works by inhibiting cyclooxygenase.” C. “Argatroban, which is a direct thrombin inhibitor that works by binding to thrombin.” D. “Streptokinase, which is a thrombolytic agent that works by converting plasminogen to plasmin.”

Answer and Explanation

Choice A:

Choice A is wrong because warfarin, which is an oral anticoagulant that works by blocking vitamin K, is contraindicated in patients with HIT, as it can cause skin necrosis and limb gangrene due to microvascular thrombosis. Warfarin also has a delayed onset of action and requires monitoring of the international normalized ratio (INR).

Choice B:

Choice B is wrong because aspirin, which is an antiplatelet agent that works by inhibiting cyclooxygenase, is also contraindicated in patients with HIT, as it can increase the risk of bleeding and does not prevent thrombosis. Aspirin also has a long-lasting effect on platelet function and can interact with other drugs.

Choice C:

Argatroban, which is a direct thrombin inhibitor that works by binding to thrombin. This is because argatroban is an alternative anticoagulant that can be used for patients with HIT, as it does not cause platelet aggregation or activation. Argatroban directly inhibits thrombin, which is the enzyme that converts fibrinogen to fibrin and activates platelets.

Choice D:

Choice D is wrong because streptokinase, which is a thrombolytic agent that works by converting plasminogen to plasmin, is not indicated for patients with HIT, as it can cause severe bleeding complications and allergic reactions. Streptokinase also has a short half-life and requires continuous infusion.

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Question 5:

A nurse is administering protamine sulfate to a client who has received an overdose of heparin. What are some important nursing considerations for this medication?

A. Protamine sulfate should be given slowly intravenously within 30 minutes of heparin administration. B. Protamine sulfate should be given rapidly intramuscularly within 60 minutes of heparin administration. C. Protamine sulfate should be given slowly intravenously within 60 minutes of heparin administration. D. Protamine sulfate should be given rapidly intramuscularly within 30 minutes of heparin administration.

Answer and Explanation

Choice A:

Protamine sulfate should be given slowly intravenously within 30 minutes of heparin administration. This is because protamine sulfate is a strong base that neutralizes the anticoagulant effect of heparin, which is a strong acid. Protamine sulfate should be given within 30 minutes of heparin administration to prevent excessive bleeding or hemorrhage. Protamine sulfate should be given slowly intravenously to avoid adverse effects such as hypotension, bradycardia, pulmonary edema, and anaphylaxis.

Choice B:

Choice B is wrong because protamine sulfate should not be given rapidly or intramuscularly. Rapid administration can cause severe hypotension and shock, and intramuscular administration can cause local irritation and hematoma formation.

Choice C:

Choice C is wrong because protamine sulfate should not be given more than 60 minutes after heparin administration. The half-life of heparin is 60 to 90 minutes, and the anticoagulant effect of heparin will usually wear off within a few hours after discontinuation. Giving protamine sulfate after 60 minutes may cause excess anticoagulation or “heparin rebound” due to the longer half-life of protamine sulfate. Choice D is wrong for the same reasons as choice B. Protamine sulfate should not be given rapidly or intramuscularly.

Choice D:

Choice D is wrong for the same reasons as choice B.Protamine sulfate should not be given rapidly or intramuscularly.

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Heparins

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