A patient on heparin develops gum bleeding and easy bruising. What is the nurse's immediate action?

• A. Continue infusion and monitor.
• B. Stop all medications.
• C. Increase the infusion rate.
• D. Check the heparin order and hold the infusion per protocol; notify the prescriber.

Answer: (D)

Bleeding while a patient is receiving heparin indicates potential over-anticoagulation, so the priority is to stop further anticoagulation and involve the prescriber promptly. The nurse should check the current heparin order and pause the infusion according to protocol, preventing more heparin from entering the system while you assess the situation. After halting the infusion, notify the prescriber right away so they can decide on the next steps—whether to adjust the dose, alter the infusion rate, discontinue the drug, or administer reversal if indicated. While awaiting orders, monitor the patient closely (vital signs, bleeding at sites, and relevant labs such as aPTT or platelet count) and apply direct pressure to any active bleeding. These actions target the immediate risk and ensure the clinician guides any further reversal or treatment.