For which of the following situations should the nurse prepare ...

[ahriuashd]

For which of the following situations should the nurse prepare for administration of protamine sulfate?
 
  a. Patient on warfarin with INR of 4 and tarry stools
  b. Patient on warfarin with PT of 12 seconds and bleeding from a laceration
  c. Patient on a heparin drip with a PTT >120 seconds and active GI bleeding
  d. Patient on a heparin drip with a PTT of 60 seconds and pink-tinged urine in the catheter bag

Question 2

Which of the following patients is most likely to be receiving ticlopidine (Ticlid)?
 
  a. A patient with a pulmonary embolism
  b. A patient with thrombotic thrombocytopenia purpura
  c. A patient with DVT, as an adjunct to warfarin (Coumadin)
  d. A patient with multiple risk factors for thrombotic stroke, as prophylaxis

[thall411]

Answer to Question 1

ANS: C
Because the PTT is well beyond the therapeutic range for a patient on a heparin drip (60 to 80 seconds) and the patient is actively bleeding, the nurse should anticipate administration of protamine sulfate to reverse the effects of the heparin.
Although the patient's INR may be within the therapeutic range for the specific problem requiring warfarin, the patient is experiencing signs of bleeding and may need to receive vitamin K (the antidote).
The patient's PT is normal, and normal clotting mechanisms will take over to stop the bleeding. No drug intervention is required.
The PTT is within the therapeutic range for a patient on a heparin drip. Although the urine is pink tinged, the nurse should consider the possibility of trauma from the catheter and should continue to observe for signs of gross hematuria before taking further action.

Answer to Question 2

ANS: D
The only approved indication for ticlopidine is prevention of thrombotic stroke. It is not used for any other reason. Because it can cause life-threatening adverse effects, ticlopidine should be reserved for patients who cannot tolerate aspirin or who have not responded to aspirin therapy.
Heparin and warfarin are drugs used to treat pulmonary embolism.
Thrombotic thrombocytopenia purpura (TTP) is a potential but rare side effect of ticlopidine.

[ahriuashd]

Excellent

[nguyenhoanhat]

TYSM