Author Question: A client with a newly placed prosthetic heart valve will be maintained on long-term anticoagulant ... (Read 34 times)

Chelseaamend · **on:** Jul 23, 2018

A client with a newly placed prosthetic heart valve will be maintained on long-term anticoagulant therapy. Which medication does the nurse anticipate being used for this purpose?

1. Enoxaparin (Lovenox)
2. Dalteparin (Fragmin)
3. Heparin
4. Warfarin (Coumadin)

Question 2

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and indwelling urinary catheter. A stat partial thromboplastin time (PTT) is drawn according to heparin protocol. The result is 224 seconds.

Which action by the nurse is the most appropriate?
1. Notify the health care provider and prepare to administer protamine sulfate.
2. Stop the infusion, increase the IV rate, and prepare to administer aminocaproic acid (Amicar).
3. Notify the supervisor and obtain a unit of clotting factors.
4. Call the health care provider and prepare to administer vitamin K.

bubulittle310@msn.cn · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 4
Rationale 1: Lovenox is used for short-term anticoagulation.
Rationale 2: Fragmin is used for short-term anticoagulation.
Rationale 3: Heparin is not used for long-term therapy.
Rationale 4: Warfarin (Coumadin) is the drug of choice for long-term anticoagulation in a client with a prosthetic heart valve.
Global Rationale: Warfarin (Coumadin) is the drug of choice for long-term anticoagulation in a client with a prosthetic heart valve. Lovenox and Fragmin are used for short-term anticoagulation. Heparin is not used for long-term therapy.

Answer to Question 2

Correct Answer: 1
Rationale 1: Bleeding accompanied by a PTT of 224 indicates dangerously high overheparinization. Notification of the health care provider is essential. Protamine sulfate is administered to neutralize the anticoagulant activity of heparin.
Rationale 2: Amicar is indicated for bleeding from conditions such as aplastic anemia, hepatic cirrhosis, postoperative cardiac surgery, and in certain cancers. It is not given if the client has urinary tract bleeding.
Rationale 3: Clotting factors would not immediately lower the elevated PTT, and would not stop the bleeding the client is experiencing.
Rationale 4: Vitamin K would not immediately lower the elevated PTT and would not stop the bleeding the client is experiencing.
Global Rationale: Bleeding accompanied by a PTT of 224 indicates dangerously high overheparinization. Notification of the health care provider is essential. Protamine sulfate is administered to neutralize the anticoagulant activity of heparin. Amicar is indicated for bleeding from conditions such as aplastic anemia, hepatic cirrhosis, postoperative cardiac surgery, and in certain cancers. It is not given if the client has urinary tract bleeding. Clotting factors and vitamin K would not immediately lower the elevated PTT, and would not stop the bleeding the client is experiencing.