A nurse is caring for a client who has variant angina and is prescribed verapamil. Which of the following are expected outcomes of this medication? (Select all that apply.)

The correct answer is choice A) Activated partial thromboplastin time (aPTT).This is because aPTT is the most commonly used laboratory test to monitor the therapeutic effect of heparin therapy.

Heparin is an anticoagulant that inhibits the formation of thrombin and fibrin, which are essential for blood clotting.Heparin therapy is indicated for the treatment of deep vein thrombosis (DVT), which is a condition where blood clots form in the deep veins of the legs or pelvis.

Choice B) Prothrombin time (PT) is wrong because PT is used to monitor the therapeutic effect of warfarin therapy, not heparin therapy.

Warfarin is another anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors.Warfarin therapy is also indicated for the treatment of DVT, but it has a different mechanism of action and monitoring than heparin therapy.

Choice C) International normalized ratio (INR) is wrong because INR is a standardized way of reporting PT results that accounts for the variability of different laboratory methods.INR is also used to monitor the therapeutic effect of warfarin therapy, not heparin therapy.

Choice D) Platelet count is wrong because platelet count is not directly affected by heparin therapy.However, platelet count should be monitored periodically in patients receiving heparin therapy to detect heparin-induced thrombocytopenia (HIT), which is a rare but serious complication of heparin therapy that causes a drop in platelet count and an increased risk of thrombosis.

Choice E) Hemoglobin is wrong because hemoglobin is not directly affected by heparin therapy.However, hemoglobin should be monitored periodically in patients receiving heparin therapy to detect bleeding complications, which are the most common adverse effects of heparin therapy.

The normal range for aPTT is 25 to 35 seconds, but the therapeutic range for heparin therapy is usually 1.5 to 2.5 times the normal range, depending on the indication and protocol.

The normal range for PT is 11 to 13 seconds, and the therapeutic range for warfarin therapy is usually an INR of 2 to 3, depending on the indication and protocol

A history of stroke is an absolute contraindication to the administration of a thrombolytic to a patient having an acute myocardial infarction (AMI).This is because thrombolytics can increase the risk of intracranial hemorrhage and worsen the neurological outcome.

Choice A is wrong because history of hypertension is not an absolute contraindication, but a relative one.This means that the benefits of thrombolytic therapy may outweigh the risks in some cases, depending on the severity and duration of hypertension.

Choice C is wrong because history of peptic ulcer disease is also a relative contraindication, not an absolute one.Thrombolytics can increase the risk of gastrointestinal bleeding, but this can be managed with proton pump inhibitors or histamine-2 blockers.

Choice D is wrong because history of diabetes mellitus is not a contraindication at all to thrombolytic therapy.In fact, some studies have shown that diabetic patients with AMI may benefit more from thrombolytic therapy than non-diabetic patients.