A client weighing 76 \text{ kg} is receiving a continuous intravenous (IV) infusion of unf… — NCLEX-RN

A client weighing $76 \text{ kg}$ is receiving a continuous intravenous (IV) infusion of unfractionated heparin for a deep vein thrombosis. The current infusion rate is $16 \text{ units/kg/hr}$ . The IV bag is labeled "Heparin sodium $25,000 \text{ units}$ in $500 \text{ mL}$ $0.45\% \text{ NaCl}$ ". The client's morning activated partial thromboplastin time (aPTT) result is $112 \text{ seconds}$ (reference range: $30-40 \text{ seconds}$ ).

The facility's heparin titration protocol specifies the following actions based on aPTT results:
- aPTT $71-90 \text{ seconds}$ : Decrease infusion rate by $2 \text{ units/kg/hr}$ .
- aPTT $> 90 \text{ seconds}$ : Stop the infusion for $1$ hour, then decrease the rate by $3 \text{ units/kg/hr}$ .

Based on the protocol, which sequence of actions and newly programmed IV pump rate should the nurse implement? (Round the final pump rate to the nearest tenth).

A
Decrease the IV pump rate immediately to $19.8 \text{ mL/hr}$ and monitor the client for hematuria.
B
Stop the IV infusion for $1$ hour, then restart the pump at $21.3 \text{ mL/hr}$ .
Stop the IV infusion for $1$ hour, then restart the pump at $19.8 \text{ mL/hr}$ .Cevap
D
Stop the IV infusion for $1$ hour, then restart the pump at $9.9 \text{ mL/hr}$ .

Cevap

Stop the IV infusion for

1

hour, then restart the pump at

19.8 \text{ mL/hr}

The correct answer accurately synthesizes clinical prioritization with complex medication math. Because the aPTT (

112 \text{ seconds}

) is greater than

90 \text{ seconds}

, the priority is to stop the infusion for

1

hour to mitigate bleeding risk. The new dose is calculated by subtracting

3 \text{ units/kg/hr}

from the current rate, yielding

13 \text{ units/kg/hr}

. Multiplying this by the client's weight (

76 \text{ kg}

) gives

988 \text{ units/hr}

. Dividing the required units by the solution concentration (

25,000 \text{ units} / 500 \text{ mL} = 50 \text{ units/mL}

) results in

19.76 \text{ mL/hr}

, which correctly rounds to

19.8 \text{ mL/hr}

Adım Adım Çözüm

Interpret the laboratory result against the protocol.

The aPTT is

112 \text{ seconds}

, which falls into the

> 90 \text{ seconds}

category.

Determines the correct clinical intervention to prevent severe hemorrhage.

Identify the required immediate action.

The infusion must be stopped for

1

hour.

Allows the dangerously high level of anticoagulation to begin wearing off.

Calculate the new weight-based dose.

16 \text{ units/kg/hr} - 3 \text{ units/kg/hr} = 13 \text{ units/kg/hr}

The protocol requires a decrease of

3 \text{ units/kg/hr}

for this critical value.

Calculate the total units required per hour.

76 \text{ kg} \times 13 \text{ units/kg/hr} = 988 \text{ units/hr}

Converts the weight-based dose into the total required hourly dose.

Calculate the concentration of the IV solution.

25,000 \text{ units} \div 500 \text{ mL} = 50 \text{ units/mL}

Required to convert the ordered dose (units) into the pump setting (mL).

Calculate the final IV pump rate.

988 \text{ units/hr} \div 50 \text{ units/mL} = 19.76 \text{ mL/hr}

. Rounded to the nearest tenth, this is

19.8 \text{ mL/hr}

Determines the exact volume to program into the infusion pump.

Anahtar Kavram

High-risk medication titration requires precise weight-based calculations and strict adherence to protocols, prioritizing the temporary suspension of therapy when critical laboratory values indicate impending harm.

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