# Review the chart for a postoperative client receiving unfractionated heparin. Which action should the nurse take first?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Review the chart for a postoperative client receiving unfractionated heparin. Which action should the nurse take first?

History

Vitals

Labs

Orders

Notes

Postoperative day 7 after hip surgery; unfractionated heparin infusion is being used for a new pulmonary embolism.

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1

Continue heparin until the PF4 immunoassay and functional assay are both final.

✕

2

Stop every heparin source, notify the authorized team, and prepare the ordered non-heparin anticoagulant and HIT testing.

✕

3

Administer prophylactic platelets before evaluating the new leg thrombosis.

✕

4

Reduce the heparin rate by half and repeat the platelet count next week.

✕

## Explanation

A platelet fall greater than 50 percent on day 7 with new thrombosis creates high clinical concern for HIT and requires stopping heparin and starting an authorized non-heparin anticoagulant while testing proceeds.

## In-depth explanation

Quick answer
Act on intermediate or high clinical probability of HIT.

Why this is correct
ASH recommends the 4Ts score rather than gestalt. With an intermediate or high probability, heparin is discontinued, a non-heparin anticoagulant is started at the indicated intensity, and an immunoassay is obtained.

Easy analogy or mental picture
The falling platelet count is not simply a bleeding problem; it can signal a clot-producing immune reaction.

Memory hook
Day 5 to 14, platelets down, new clot: stop all heparin.

NCLEX decision rule
Do not wait for every confirmatory result when the clinical probability and thrombosis risk are high.

Why the other choices are wrong
Continuing or merely reducing heparin sustains the trigger, while routine platelet transfusion does not treat the prothrombotic mechanism.References
1ASH Guideline: Heparin-Induced Thrombocytopenia4Ts assessment, stopping heparin, testing, and initiation of a non-heparin anticoagulant

## Clinical scenario

HIT safety screen
Calculate the 4Ts score, identify all heparin sources including flushes, assess thrombosis and bleeding, obtain ordered tests, and monitor the selected non-heparin anticoagulant.

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