A client admitted through the emergency department requires emergency surgery and has been receiving heparin. Which nursing intervention is essential?

• A. Teach the client about phenytoin.
• B. Administer protamine sulfate.
• C. Assess the INR before surgery.
• D. Administer vitamin K.

Answer: (B)

Handling a client who has been on heparin and needs emergency surgery centers on reversing the anticoagulant effect quickly to minimize bleeding during the procedure. Protamine sulfate acts as the antidote to heparin by binding and neutralizing its activity, allowing coagulation to return toward normal so surgery can proceed with a lower risk of excessive bleeding. In this situation, the priority isn’t checking INR, which reflects warfarin’s effect rather than heparin’s, but reversing the heparin with protamine sulfate and then confirming reversal with appropriate coagulation monitoring. Vitamin K reverses warfarin, not heparin, and phenytoin has no role in reversing heparin’s anticoagulant effect. Remember to monitor the patient for potential protamine reactions and reassess coagulation status after administration to ensure adequate reversal before surgery.