An 82-year-old client with chronic kidney disease (estimated glomerular filtration rate 22 mL/min/1.73 m²) and atrial fibrillation is hospitalized for a pulmonary embolism. The provider prescribes an intravenous unfractionated heparin bolus followed by a continuous infusion; current medications include aspirin and metoprolol. Incorrect dosing may cause major bleeding or clot progression. What is the nurse's PRIORITY action before starting the heparin infusion?
- Start the infusion and plan to check activated partial thromboplastin time in 6 hours per protocol
- Ask the nursing assistant to recheck the client's weight and report back before the infusion begins
- Have a second licensed nurse independently verify the ordered bolus and infusion rate against the protocol and pump settings (correct answer)
- Document the infusion start time and initial pump settings in the medication administration record before verification
Explanation: This question tests understanding of high-alert medication protocols and independent double-checks for anticoagulant therapy. The critical safety framework involves independent verification of heparin dosing and pump programming, especially crucial given the patient's renal impairment which affects drug clearance. Option C ensures the highest safety standard by requiring a second licensed nurse to independently verify the bolus dose, infusion rate, protocol adherence, and pump settings before initiation. Option A starts without verification risking bleeding, option B delegates weight confirmation to unlicensed personnel which doesn't address dose verification, and option D documents before verifying which violates proper sequencing. The decision-making principle is that all anticoagulant infusions require independent double-checks of dose calculations and pump programming to prevent hemorrhagic or thrombotic complications. A transferable strategy is to always obtain independent verification from another licensed nurse for anticoagulant orders, particularly focusing on dose calculations, pump settings, and protocol adherence before starting any infusion.