A nurse is reporting a client’s laboratory tests to the provider to obtain a prescription for the client’s daily warfarin.

Which of the following laboratory tests should the nurse plan to report to obtain the prescription for the warfarin?

INR

Fibrinogen level

aPTT

Platelet count

Answer and Explanation

The Correct Answer is A

The correct answer is choice A. INR.

Warfarin is a vitamin K antagonist that inhibits the synthesis of factors II, VII, IX, and X in the liver.

These factors are part of the extrinsic and common pathways of coagulation, which are measured by the prothrombin time (PT) and the international normalized ratio (INR).

The INR is a standardized way of reporting the PT that accounts for the variability of different reagents and instruments.

The INR is used to monitor the therapeutic effect of warfarin and to adjust the dose accordingly.

The target INR range depends on the indication for warfarin, but it is usually between 2 and 3 for most conditions.

Choice B is wrong because fibrinogen level is not affected by warfarin.

Fibrinogen is a precursor of fibrin, which forms the final step of the coagulation cascade.

Fibrinogen level can be decreased in conditions such as disseminated intravascular coagulation (DIC), liver disease, or severe bleeding. Choice C is wrong because aPTT is not affected by warfarin.

aPTT measures the intrinsic and common pathways of coagulation, which are mainly dependent on factors VIII, IX, XI, and XII.

These factors are not inhibited by warfarin.

aPTT is used to monitor the effect of heparin, a direct antithrombin agent that inhibits thrombin and factor Xa.

Choice D is wrong because platelet count is not affected by warfarin.

Platelets are cell fragments that adhere to damaged blood vessels and form aggregates to initiate hemostasis.

Platelet count can be decreased in conditions such as immune thrombocytopenia (ITP), heparin-induced thrombocytopenia (HIT), or bone marrow suppression.

Normal ranges:

INR: 0.8-1.2
Fibrinogen: 200-400 mg/dL
aPTT: 25-35 seconds
Platelet count: 150-450 x 10^9/L References:

Nursing Test Bank

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Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"C"}

Explanation

The nurse should first administer oxygen at 2 L/min via nasal cannula because the client has signs of hypoxemia (low oxygen saturation) and respiratory distress (increased respiratory rate) that may worsen the chest pain and myocardial ischemia. Oxygen therapy can help improve oxygen delivery to the heart muscle and reduce the workload of the heart.
The nurse should then administer sublingual nitroglycerin as prescribed because nitroglycerin is a vasodilator that can help relieve chest pain by dilating the coronary arteries and improving blood flow to the heart. Nitroglycerin can also lower blood pressure and reduce cardiac preload and afterload, which can decrease myocardial oxygen demand.
Other choices:

• Prepare the client for cardiac catheterization: This may be a later intervention if the chest pain persists or if the client has a confirmed myocardial infarction, but it is not the first priority for the nurse. Cardiac catheterization is an invasive procedure that involves inserting a catheter into a large artery and advancing it to the coronary arteries to visualize any blockages or stenosis. The procedure may also involve angioplasty or stent placement to restore blood flow to the affected area.

• Request a prescription for an increase in statin: This may be a long-term intervention to lower the client’s LDL cholesterol and prevent further plaque formation in the coronary arteries, but it is not an immediate intervention for chest pain. Statins are lipid-lowering drugs that can reduce the risk of cardiovascular events in clients with CAD, but they do not have a direct effect on chest pain or myocardial ischemia.

• Check a STAT cardiac troponin: This may be a diagnostic test to confirm or rule out a myocardial infarction, but it is not an intervention for chest pain. Cardiac troponin is a protein that is released into the bloodstream when there is damage to the heart muscle. Elevated levels of cardiac troponin indicate a myocardial infarction or other cardiac injury.

• Request a prescription for a beta-blocker: This may be an adjunctive therapy to reduce chest pain and prevent complications, but it is not the first-line intervention for chest pain. Beta-blockers are drugs that block the effects of adrenaline on the heart and blood vessels, which can lower heart rate, blood pressure, and myocardial oxygen demand. Beta-blockers can also prevent arrhythmias and reduce mortality in clients with CAD.

A. A client who is receiving heparin for deep-vein thrombosis. B. A client who is 1 day postoperative following a vertebroplasty. C. A client who has cancer and a sealed implant for radiation therapy. D. A client who has COPD and a respiratory rate of 44/min.

Correct Answer is B

Explanation

The correct answer is choice B. A client who is 1 day postoperative following a vertebroplasty. A vertebroplasty is a procedure that injects cement into a fractured vertebra to help relieve pain and stabilize the spine. The recovery time for this procedure is usually short and the complications are rare.

Therefore, this client is most likely to be stable and ready for early discharge.

Choice A is wrong because a client who is receiving heparin for deep-vein thrombosis (DVT) needs close monitoring of their blood levels and clotting factors. Heparin is a blood thinner that prevents the clots from getting bigger or breaking loose and traveling to the lungs, which can cause a life-threatening condition called pulmonary embolism (PE).

This client is not a good candidate for early discharge.

Choice C is wrong because a client who has cancer and a sealed implant for radiation therapy needs to be isolated in a special room to prevent exposure of others to radiation. A sealed implant is a small holder that contains a radioactive source that is placed inside or near the tumor to deliver high doses of radiation. This type of internal radiation therapy, also called brachytherapy, can last from several minutes to several days, depending on the type and dose of the radioactive source.

This client is not a good candidate for early discharge.

Choice D is wrong because a client who has COPD and a respiratory rate of 44/min has signs of respiratory distress and possible hypoxemia (low oxygen levels in the blood).

COP

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A nurse is reporting a client’s laboratory tests to the provider to obtain a prescription for the client’s daily warfarin. Which of the following laboratory tests should the nurse plan to report to obtain the prescription for the warfarin?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"C"}

Explanation

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A nurse is reporting a client’s laboratory tests to the provider to obtain a prescription for the client’s daily warfarin.

Which of the following laboratory tests should the nurse plan to report to obtain the prescription for the warfarin?