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    HESI PN Exit 2023 II Proctored Exam

    A nurse is administering protamine sulfate to a client who has received an overdose of heparin. What are some important nursing considerations for this medication? *.

    Explanation & Rationale

    Choice A rationale: Administering protamine sulfate slowly intravenously within 30 minutes of heparin administration is not the recommended route and timing for reversing heparin's effects. Protamine sulfate is typically given slowly intravenously within 60 minutes of heparin administration. Choice B rationale: Administering protamine sulfate rapidly intramuscularly within 60 minutes of heparin administration is not the recommended route for this medication. Protamine sulfate should be given intravenously, not intramuscularly. Choice C rationale: Protamine sulfate should be given slowly intravenously within 60 minutes of heparin administration. This is the correct route and timing for reversing the anticoagulant effects of heparin. Choice D rationale: Administering protamine sulfate rapidly intramuscularly within 30 minutes of heparin administration is not the recommended route and timing for this medication. Intravenous administration is preferred for a more controlled and predictable reversal of heparin's effects.

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