Editing Pharmacology – RN Practice Questions (section)

==Question 11==
The nurse on a medical unit receives report on four clients. Which client should the nurse assess first?
# A client on a heparin infusion whose platelet count has fallen from 240,000 to 88,000 per microliter since admission five days ago
# A client on furosemide whose morning weight is down 1.4 kilograms
# A client on metformin scheduled for a computed tomography scan with contrast tomorrow
# A client on levothyroxine who reports taking the dose with breakfast

'''Answer:''' 1 (A) The client on a heparin infusion with a platelet count that has fallen from 240,000 to 88,000 per microliter since admission five days ago.

''Rationale:'' A drop of more than 50 percent in the platelet count occurring 5 to 10 days after heparin exposure is highly suspicious for heparin-induced thrombocytopenia, a prothrombotic emergency in which the client is at risk for limb-threatening and life-threatening thrombosis. All heparin, including flushes and coated catheters, must be stopped and a nonheparin anticoagulant substituted. Option 2 is an expected diuretic response. Option 3 requires action, holding metformin around contrast administration, but that action is not needed until tomorrow. Option 4 is a teaching opportunity because levothyroxine should be taken on an empty stomach, but it is not urgent.