A nurse is reinforcing teaching with a young adult female client who has been prescribed lisinopril.

Which of the following instructions should the nurse plan to include? (Select all that apply)

Choice A reason : A hemoglobin (Hgb) level of 16 g/dL is within the normal range for adults, which typically falls between 13.8 to 17.2 g/dL for men and 12.1 to 15.1 g/dL for women. Therefore, this value does not warrant reporting to the provider as it does not indicate an immediate concern.

Choice B reason : A prothrombin time (PT) of 45 seconds is significantly higher than the normal range of 11 to 13.5 seconds for individuals not on anticoagulation therapy. For patients on warfarin, the target PT is usually 1.5 to 2 times the normal value, depending on the indication for therapy. However, a PT of 45 seconds suggests a high risk of bleeding and requires immediate medical attention.

Choice C reason : The activated partial thromboplastin time (aPTT) of 36 seconds is within the normal range of approximately 21 to 35 seconds⁸. This result indicates that the blood's intrinsic clotting pathway is functioning within expected parameters and does not need to be reported.

Choice D reason : A platelet count of 190,000/mm is within the normal range, which is typically 150,000 to 450,000 platelets/mm. This value is not concerning and does not need to be reported to the provider.

Choice A reason : This instruction is accurate because for a standard 12-lead ECG, electrodes are placed on the patient's chest and extremities to record the electrical activity of the heart. The placement of these electrodes is crucial for accurate readings and diagnosis. The electrodes do not emit electricity; they merely record and measure the electrical activity in your heart, providing essential information to the medical provider.

Choice B reason : Remaining still during an ECG is important to prevent artifacts that can interfere with the interpretation of the heart's electrical activity. Movement can cause the readings to be inaccurate, which is why patients are advised to remain still once the electrodes are in place.

Choice C reason : While the client might feel some pressure from the electrodes, the term 'tingling' is not accurate as the ECG is a painless procedure. The electrodes may cause mild irritation upon the skin, but there is otherwise no sensation associated with the test itself.

Choice D reason : The duration of the test is indeed short, typically only a few minutes, but this is not the primary instruction. The nurse should first inform the client about the electrode placement, which is essential for the procedure. The ECG will only take a few minutes in total once the procedure is underway, not counting equipment set-up time.