A client with a pulmonary embolism is receiving a continuous intravenous (IV) heparin infu… — NCLEX-RN

A client with a pulmonary embolism is receiving a continuous intravenous (IV) heparin infusion at $1,200\text{ units/hr}$ . The pharmacy provides heparin as $25,000\text{ units}$ mixed in $250\text{ mL}$ of $5\%$ dextrose in water ( $D_5W$ ). The client's morning activated partial thromboplastin time (aPTT) is $120\text{ seconds}$ (normal control: $30\text{ seconds}$ ). The healthcare provider orders the nurse to hold the infusion for 1 hour and then decrease the dose by $200\text{ units/hr}$ . Which of the following actions should the nurse take regarding this client's parenteral therapy?

Program the electronic infusion pump to deliver $10\text{ mL/hr}$ when resuming the heparin infusion.Answer
B
Set the infusion rate to $14\text{ mL/hr}$ for the first hour after the pause to replace the missed medication.
C
Utilize the paused IV line to administer a scheduled IV piggyback antibiotic without verifying compatibility.
D
Prioritize administering intravenous protamine sulfate before assessing the client's vital signs and observing for active bleeding.

Answer

The correct action is to program the electronic infusion pump to deliver 10 mL/hr when resuming the infusion.

The correct answer demonstrates accurate dosage calculation for a high-alert parenteral medication. The concentration of the heparin drip is

100\text{ units/mL}

(

25,000\text{ units} \div 250\text{ mL}

). The new ordered dose is

1,000\text{ units/hr}

(

1,200\text{ units} - 200\text{ units}

). Dividing the new dose by the concentration yields a safe and accurate pump rate of

10\text{ mL/hr}

Step-by-Step Solution

Analyze the client's laboratory data and the provider's order.

The aPTT of 120 seconds is critically supratherapeutic, validating the order to hold the infusion for 1 hour and decrease the dose.

Ensures the prescribed intervention aligns with the client's physiological status and safety protocols.

Calculate the concentration of the available heparin solution.

25,000\text{ units} \div 250\text{ mL} = 100\text{ units/mL}

The concentration is required to convert the ordered dose (units/hr) into a pump rate (mL/hr).

Determine the new prescribed dose per hour.

1,200\text{ units/hr} - 200\text{ units/hr} = 1,000\text{ units/hr}

The provider ordered a rate decrease of 200 units/hr from the previous baseline.

Calculate the new electronic infusion pump rate.

1,000\text{ units/hr} \div 100\text{ units/mL} = 10\text{ mL/hr}

Infusion pumps are programmed in mL/hr, necessitating the final conversion.

Key Concept

Safe dosage calculation, administration principles, and troubleshooting of high-alert continuous intravenous medications.

Estimated Time:1m 30s

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