A critical action by the nurse caring for a patient with an acute ...

[tiara099]

A critical action by the nurse caring for a patient with an acute exacerbation of polycythemia vera is to
 
  a. place the patient on bed rest.
  b. administer iron supplements.
  c. avoid use of aspirin products.
  d. monitor fluid intake and output.

Question 2

A patient who has been receiving a heparin infusion and warfarin (Coumadin) for a deep vein thrombosis (DVT) is diagnosed with heparin-induced thrombocytopenia (HIT) when her platelet level drops to 110,000/L.
 
  Which action will the nurse include in the plan of care?
  a. Use low-molecular-weight heparin (LMWH) only.
  b. Administer the warfarin (Coumadin) at the scheduled time.
  c. Teach the patient about the purpose of platelet transfusions.
  d. Discontinue heparin and flush intermittent IV lines using normal saline.

[Laurenleakan]

Answer to Question 1

ANS: D
Monitoring hydration status is important during an acute exacerbation because the patient is at risk for fluid overload or underhydration. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.

Answer to Question 2

ANS: D
All heparin is discontinued when the HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150,000/L. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.