A nurse caring for a patient receiving heparin therapy notes that ...

[Capo]

A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color.
 
  A stat CBC shows a platelet count of less than 100,000 mm3 . The nurse will: a. administer oxygen and notify the provid-er.
  b. discontinue the heparin and notify the provider.
  c. request an order for protamine sulfate.
  d. request an order for vitamin K (phytona-dione).

Question 2

A patient is being discharged home on enteric-coated aspirin (Ecotrin). A nurse is providing patient education regarding the rationale for the enteric coating.
 
  Which statement made by the patient indicates understanding of the purpose of the enteric coating on the aspirin? a. Enteric coating will allow the aspirin to be released a little at a time throughout the day.
  b. Enteric coating means that the aspirin will not be broken down by the liver.
  c. Enteric coating means that the aspirin can be broken down easier and eliminated by the kidney.
  d. Enteric coating means that the acids of the gut will not destroy the aspirin.

[tuate]

Answer to Question 1

B
This patient is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified. The purplish color of the finger-tips is caused by thrombosis, not hypoxia, so oxygen is not indicated. This patient may need con-tinued anticoagulation therapy, so a request for protamine sulfate is not correct. Heparin is not a vitamin K inhibitor.

Answer to Question 2

D
The purpose of enteric coating is to prevent the acids of the stomach from destroying the medi-cation before it is effectively utilized by the body.
Sustained-release formulations allow medications to be released a little at a time throughout the day.
The first-pass effect is a process whereby a medication is broken down by the liver.
Excretion refers to the elimination of a medication's metabolic byproducts by the kidneys.

DIF: Cognitive Level: Analysis REF: p. 35
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies