A nurse is reviewing laboratory data from a client who has a pulmonary embolism and is receiving IV heparin.
Which of the following findings should the nurse report to the provider?
Patient's platelets 100,000.
Prothrombin time (PT) 12 seconds.
Thrombin time (TT) 55 seconds.
Hematocrit 35%.
The Correct Answer is A
“Patient’s platelets 100,000.” A nurse should report a low platelet count to the provider because it may indicate heparin-induced thrombocytopenia (HIT), a serious complication of heparin therapy.
Choice B is not correct because a Prothrombin time (PT) of 12 seconds is within the normal range and does not need to be reported.
Choice C is not correct because Thrombin time (TT) is not typically used to monitor heparin therapy.
Choice D is not correct because a Hematocrit of 35% is within the normal range and does not need to be reported.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
“Inject the medication into the abdomen above the level of the iliac crest.” When administering heparin subcutaneously, it is appropriate to inject the medication into the abdomen above the level of the iliac crest 1.
Choice A is not correct because a 1-inch needle may be too long for subcutaneous injection.
A shorter needle, such as a 3/8 to 5/8 inch needle, is typically used for subcutaneous injections.
Choice B is not correct because a 22-gauge needle may be too large for subcutaneous injection.
A smaller gauge needle, such as a 25- or 27-gauge needle, is typically used for subcutaneous injections.
Choice C is not correct because massaging the injection site after administering heparin can increase the risk of bruising and should be avoided.
Correct Answer is A
Explanation
“Inject air into the regular insulin first.” When mixing regular insulin and NPH insulin in the same syringe, the nurse should instruct the client to inject air into the NPH insulin vial first, then inject air into the regular insulin vial.
After that, the client should draw up the regular insulin into the syringe first, followed by the NPH insulin.
Choice B is not correct because NPH insulin should not be shaken vigorously as it can damage the insulin molecules.
Choice C is not correct because the regular insulin should be drawn up into the syringe first.
Choice D is not correct because regular insulin is a clear solution and should not appear cloudy.
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