A nurse is caring for a client who is at 38 weeks of gestation, is in active labor, and has ruptured membranes. Which of the following actions should the nurse take?

Rationale:

A. Nurses notes are used to create the critical pathway: Critical pathways are developed from evidence-based clinical guidelines and best practices, not directly from nurses’ notes. While documentation may help track progress, it is not the foundation for pathway creation.

B. Critical pathways should reduce health care costs: Critical pathways standardize care for specific diagnoses, promoting timely interventions and reducing unnecessary treatments or delays. This efficiency helps lower healthcare costs while improving patient outcomes.

C. Critical pathways have an unlimited timeframe for completion: Each critical pathway includes a defined timeline with expected outcomes for each phase of care. This structure ensures care is efficient and progress is monitored closely to prevent delays or complications.

D. Nurses should discontinue the critical pathway if variances occur: Variances are deviations from the expected outcomes and are used to evaluate and adjust care. They do not justify discontinuing the entire pathway but rather indicate a need for reassessment or individualized modifications.

Rationale:

A. Fibrinogen level: Fibrinogen is a clotting factor that can reflect coagulation activity, but it is not used to monitor warfarin therapy. It is more relevant in conditions like DIC or liver disease, not for warfarin dose adjustments.

B. aPTT: Activated partial thromboplastin time (aPTT) is used to monitor heparin therapy. Warfarin, which affects the extrinsic pathway of coagulation, does not significantly impact aPTT levels.

C. INR: The international normalized ratio (INR) is the standard test used to monitor warfarin therapy. It reflects the effect of warfarin on prothrombin time and guides safe and effective dosing to maintain therapeutic anticoagulation.

D. Platelet count: While platelet count helps evaluate bleeding risk and detect thrombocytopenia, it is not used to guide warfarin dosing. Warfarin works by inhibiting vitamin K–dependent clotting factors, not by affecting platelet production.