# A nurse is reviewing the laboratory results of a client who is receiving intravenous heparin for a deep vein thrombosis. The client's platelet count was 250,000/mm³ before starting heparin 7 days ago and is now 80,000/mm³. The client reports new pain and swelling in the opposite leg. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505801&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A nurse is reviewing the laboratory results of a client who is receiving intravenous heparin for a deep vein thrombosis. The client's platelet count was 250,000/mm³ before starting heparin 7 days ago and is now 80,000/mm³. The client reports new pain and swelling in the opposite leg. Which action should the nurse take first?

## Option

1. Administer the scheduled heparin dose and monitor the platelet count.
2. Stop the heparin infusion and notify the healthcare provider. **✔ Correct answer**
3. Apply warm compresses to the swollen leg and elevate the extremity.
4. Obtain a stat venous Doppler ultrasound of the affected leg.

**Correct answer: 2**

## Explanation

The client's platelet count has dropped more than 50% from baseline (from 250,000 to 80,000/mm³) after 7 days of heparin therapy, and new thrombosis symptoms have developed in the opposite leg. This presentation is highly suggestive of heparin-induced thrombocytopenia (HIT) with thrombosis. The priority action is to immediately discontinue all heparin to prevent further platelet activation and thrombotic complications, and to notify the healthcare provider for evaluation and initiation of a non-heparin anticoagulant. Continuing heparin would worsen the condition. Applying warm compresses or obtaining a Doppler ultrasound are interventions that may be appropriate later but do not address the urgent need to stop the causative agent and seek alternative anticoagulation.

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