# A nurse is caring for a client prescribed Heparin. Which nursing action is most appropriate regarding monitoring aPTT levels and preparing protamine sulfate as an antidote?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=497452&lang=ja  
> language: ja  
> subject: NCLEX-RN  
> category: PPT

## 問題

A nurse is caring for a client prescribed Heparin. Which nursing action is most appropriate regarding monitoring aPTT levels and preparing protamine sulfate as an antidote?

## 選択肢

1. Monitor vital signs and assess laboratory values prior to administration. **✔ 正解**
2. Administer the medication with a full glass of water every morning.
3. Instruct the client to report any unexpected side effects immediately.
4. Verify the prescription details with the healthcare provider.

**正解: 1**

## 解説

When administering Heparin, 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.

## 詳細解説

1. Scenario: Patient taking Furosemide.
2. Recognize Cues: Evaluate 저칼륨혈증 및 기립성 저혈압 주의, 이독성 감시.
3. Take Action: Ensure safe administration protocols.
4. Evaluate: Re-assess therapeutic response.

## 重要概念

- **Furosemide (푸로세미드)** — 고리 이뇨제로 칼륨 배설을 촉진하므로 칼륨 수치와 심전도를 주의 깊게 관찰해야 해요.

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