A nurse is caring for a client prescribed Lisinopril. Which … | MyMerci
MyMerci — full questions and rationale, freeStart for free
Medication AdministrationPPT
Question
A nurse is caring for a client prescribed Lisinopril. Which nursing action is most appropriate regarding monitoring for persistent dry cough, angioedema, and hyperkalemia?
1Prophylactic platelet transfusion should be administered for a platelet count below 40,000/μL to prevent spontaneous bleeding, and HIT does not contraindicate this because the immediate risk of hemorrhage in a patient with severe thrombocytopenia outweighs the potential thrombotic complications from added platelets.✓ Correct answer
2For a patient with confirmed HIT and a platelet count of 38,000/μL, restarting unfractionated heparin at a low prophylactic infusion rate (e.g., 5 units/kg/hour) can safely maintain anticoagulation for stroke prevention while allowing gradual platelet recovery, as the platelet count is not critically low and bleeding risk is minimal.
3For a patient with confirmed HIT and a platelet count of 38,000/μL, switching to low molecular weight heparin at a reduced dose (such as enoxaparin 0.5 mg/kg twice daily) is recommended because LMWH has minimal cross-reactivity with HIT antibodies, allowing gradual platelet recovery while maintaining anticoagulation for stroke prevention.
4Platelet transfusion should generally be AVOIDED in HIT (and reserved for life-threatening bleeding only) because added platelets can fuel further IgG-PF4 mediated thrombosis; treatment focuses on stopping ALL heparin (UFH/LMWH) and starting a non-heparin anticoagulant such as argatroban or fondaparinux.
Explanation
When administering Lisinopril, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
Clinical reasoning summary HIT — platelet transfusion controversy HIT is paradoxically prothrombotic despite low platelet count. The mechanism (IgG antibodies to PF4-heparin) consumes circulating platelets via thrombosis, NOT bleeding. Adding platelet transfusion can fuel further antibody-mediated platelet activation and thrombosis.
Current ASH 2018 / CHEST guideline: • AVOID prophylactic platelet transfusion in HIT. • Transfusion is reserved for active major bleeding or imminent procedure with high bleeding risk. • Stop ALL heparin (UFH and LMWH — class effect, ~85% cross-reactivity) and start non-heparin anticoagulant: argatroban (preferred in renal impairment), bivalirudin, or fondaparinux. • Anti-PF4 ELISA + functional assay (SRA) for confirmation. • Avoid warfarin until platelets ≥150 K (early warfarin causes venous limb gangrene from protein C drop). • Lifetime heparin avoidance — alert band, MAR/EHR alert.
Options 3 and 4 (LMWH or UFH continuation) are both wrong because of class cross-reactivity (~85%). Option 1 (prophylactic platelet) feeds the disease.