Nokea
When administering heparin subcutaneously, the nurse will follow which procedure?
- A. Aspirating the syringe before injecting the medication
- B. Massaging the site after injection
- C. Use the same area for each injection.
- D. Using a 1/2- to 5/8-inch 25- to 27-gauge needle
Correct Answer: D
Rationale: A 1/2- to 5/8-inch 25- to 27-gauge needle is the correct needle to use for a subcutaneous heparin injection. Aspirating before the injection and massaging the site after the injection encourage hematoma formation at the injection site. Injection sites need to be rotated with each injection.
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A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose?
- A. To relieve chest pain
- B. To prevent further clot formation
- C. To dissolve the clot in the coronary artery
- D. To control bleeding in the coronary vessels
Correct Answer: C
Rationale: Thrombolytic drugs lyse, or dissolve, thrombi. They are not used to prevent further clot formation or to control bleeding. As a result of dissolving of the thrombi, chest pain may be relieved, but that is not the primary purpose of thrombolytic therapy.
A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance?
- A. Soy
- B. Valerian
- C. Saw palmetto
- D. St. John's wort
Correct Answer: D
Rationale: Capsicum pepper, dong quai, feverfew, garlic, ginger, ginkgo, and St. John's wort are some herbal products that have potential interactions with anticoagulants, especially with warfarin.
The nurse is reviewing new medication orders for a patient who has an epidural catheter for administration of pain medications. One of the orders is for enoxaparin, a low-molecular-weight heparin (LMWH). What is the nurse's priority action?
- A. Give the LMWH as ordered.
- B. Double-check the LMWH order with another nurse, and then administer as ordered.
- C. Stop the epidural pain medication, and then administer the LMWH.
- D. Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.
Correct Answer: D
Rationale: LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma.
An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose.
Correct Answer: 0.8 mL
Rationale: 5000 units : 1 mL :: 4000 units : x mL; (5000 * x) = (1 * 4000); 5000x = 4000; x = 4000/5000 = 0.8 mL.
A patient is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the drug's effectiveness?
- A. Bleeding times
- B. Activated partial thromboplastin time (aPTT)
- C. Prothrombin time/international normalized ratio (PT/INR)
- D. Vitamin K levels
Correct Answer: B
Rationale: Ongoing aPTT values are used to monitor heparin therapy. PT/INR is used to monitor warfarin therapy. The other two options are not used to monitor anticoagulant therapy.