A client receiving unfractionated heparin develops a painful swollen leg. The platelet count has decreased from 220,000/mm3 to 92,000/mm3. Which action should the nurse take first?
1Increase the heparin infusion because the client may have a new thrombosis
2Continue heparin and prepare to administer a platelet transfusion
3Stop heparin and report suspected heparin-induced thrombocytopenia✓ Correct answer
4Begin warfarin therapy while the platelet count remains decreased
Explanation
A platelet decline of more than half with new thrombosis during heparin exposure strongly suggests heparin-induced thrombocytopenia, a prothrombotic immune reaction. Heparin should be stopped promptly, and the provider should initiate evaluation and a non-heparin anticoagulant when indicated.
Quick answer Stop heparin and report suspected heparin-induced thrombocytopenia. New thrombosis plus a major platelet decline is a clotting emergency, not a reason to give more heparin.
Why this is correct In heparin-induced thrombocytopenia, antibodies activate platelets and create thrombosis even as the measured platelet count falls. Continuing heparin sustains the trigger, so stopping exposure and arranging alternative anticoagulation are urgent priorities.
Easy analogy or mental picture The reaction is like a fire alarm system that accidentally activates machinery that starts more fires. The falling platelet count is visible, but the major danger is thrombosis; the analogy does not replace formal probability scoring and laboratory confirmation.
Memory hook Heparin plus platelet fall plus new clot means stop heparin and switch the anticoagulation plan.
NCLEX decision rule When heparin exposure is followed by a substantial platelet decline and thrombosis, treat the pattern as suspected heparin-induced thrombocytopenia. Stop heparin, notify the provider, and expect a non-heparin anticoagulant rather than more heparin, routine platelets, or early warfarin alone.
Why the other choices are wrong Increasing or continuing heparin worsens the immune trigger. Platelet transfusion is not routine without a separate bleeding indication, and warfarin should not be started while platelets remain markedly decreased in acute HIT.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
ASH: Heparin-Induced Thrombocytopenia GuidelineAmerican Society of Hematology