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A Nurse Assessing a Client on a Heparin Drip Notes

Question 5

Multiple Choice

A nurse assessing a client on a heparin drip notes bloody drainage in the nasogastric tube and Foley catheter.A stat partial thromboplastin time (PTT) is drawn; the result is 224 seconds.The next action of the nurse should be:


A) Call the physician and prepare to administer protamine sulfate.
B) Call the physician and prepare to administer vitamin K.
C) Stop the infusion, increase the IV rate, and prepare to administer aminocaproic acid (Amicar) .
D) Notify the supervisor and obtain a unit of clotting factors.

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