Editing Pharmacology – RN Practice Questions (section)

==Question 1==
A client with a pulmonary embolism is receiving a continuous intravenous heparin infusion. The 0600 aPTT result is 96 seconds, and the control value is 30 seconds. The client has no active bleeding. Which action should the nurse take first?
# Continue the infusion at the current rate and recheck the aPTT in 6 hours
# Stop the infusion and notify the provider, anticipating a rate reduction per protocol
# Administer protamine sulfate 25 mg intravenously
# Request an order for a platelet count and fresh frozen plasma

'''Answer:''' 2 (B) Stop the infusion and notify the provider, anticipating a rate reduction per protocol.

''Rationale:'' The therapeutic aPTT target for heparin is generally 1.5 to 2.5 times the control, which is 45 to 75 seconds when the control is 30 seconds. An aPTT of 96 seconds is supratherapeutic and places the client at bleeding risk, so the nurse holds the infusion and follows the institutional heparin protocol, which typically directs a brief hold and a rate decrease. Option 1 leaves the client supratherapeutic. Option 3 is premature: protamine sulfate is the antidote but is reserved for significant bleeding or life-threatening overdose, not an isolated elevated aPTT in a client who is not bleeding. Option 4 addresses a different problem; a platelet count is appropriate to screen for heparin-induced thrombocytopenia but is not the first action, and fresh frozen plasma does not reverse heparin.