A client receiving a weight-based unfractionated heparin infusion has an aPTT of 96 seconds. The institution's nomogram directs the nurse to hold the infusion for 30 minutes, decrease the rate by 2 units/kg/hr, and repeat aPTT in 6 hours for a result of 91 to 100 seconds. Which action should the nurse take?
1Continue the current rate and repeat aPTT with the next morning laboratory tests.
2Stop the infusion permanently and request immediate conversion to oral warfarin.
3Hold the infusion for 30 minutes, restart 2 units/kg/hr lower, and repeat aPTT in 6 hours.✓ Correct answer
4Administer a heparin bolus, increase the rate, and repeat aPTT in 1 hour.
Explanation
The measured aPTT falls in the nomogram's 91- to 100-second range. The nurse should follow the specified hold, rate reduction, and 6-hour reassessment rather than applying an unstated universal range.
Quick answer Follow the provided nomogram exactly: hold 30 minutes, reduce 2 units/kg/hr, recheck in 6 hours.
Why this is correct Unfractionated heparin adjustment targets vary by laboratory reagent and institution. The question supplies the controlling protocol, and 96 seconds falls within its defined range.
Easy analogy or mental picture The nomogram is the dosing map; the laboratory value tells the nurse which lane to follow.
Memory hook Heparin: value plus local nomogram equals action.
NCLEX decision rule Use an authorized protocol for titratable high-alert infusions and document the adjustment and timed reassessment.
Why the other choices are wrong No change ignores the protocol, permanent discontinuation exceeds the finding, and a bolus plus rate increase moves in the wrong direction.
References
1DailyMed: Heparin sodium labelsLaboratory-guided individualized dosing and bleeding monitoring