A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider?

Platelets 74,000/mm3

White blood cell count 8,000/mm3

Partial thromboplastin time (PTT) 55 seconds

Hematocrit 45%

Answer and Explanation

The Correct Answer is A

A. Platelets 74,000/mm: A platelet count of 74,000/mm³ is significantly lower than the normal range (typically 150,000 to 450,000/mm³). This could indicate heparin-induced thrombocytopenia (HIT), a serious adverse effect of heparin therapy where the immune system forms antibodies against heparin bound to platelet factor 4, leading to a decrease in platelets and increased risk of thrombosis. This is a critical finding and should be reported immediately to the provider for further evaluation and potential adjustment of the treatment plan.

B. White blood cell count 8,000/mm³: This is within the normal range (typically 4,000 to 11,000/mm³) and does not indicate an immediate problem related to heparin therapy or pulmonary embolism management.

C. Partial thromboplastin time (PTT) 55 seconds: While slightly elevated, this PTT is within the therapeutic range for a patient receiving IV heparin (typically 1.5 to 2.5 times the normal control value, or about 45 to 70 seconds). This indicates that the heparin is having the desired anticoagulant effect.

D. Hematocrit 45%: This is within the normal range for adults (typically 38-50% for men and 35-45% for women) and does not indicate an immediate concern related to heparin therapy or pulmonary embolism.

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Correct Answer is C

Explanation

White Blood Cell Count (WBC): WBCs are part of the immune system and play a role in fighting infections. However, they are not directly involved in hemostasis or clot formation. WBCs do not adhere to the vessel wall during hemostasis.
Activated Partial Thromboplastin Time (aPTT): aPTT measures the time it takes for blood to clot. It is primarily used to monitor heparin therapy, not warfarin. aPTT is not specific for warfarin monitoring.
Prothrombin Time (PT): PT measures how quickly blood clots. It is used to monitor warfarin therapy and assess clotting factors. PT is essential for monitoring warfarin effectiveness.
Platelet Count: Platelets are crucial for clot formation. Platelet count helps assess platelet function. Platelets play a direct role in hemostasis.

A. Oprelvekin (Neumega) B. Epoetin alfa (Procrit) C. Clopidogrel (Plavix) D. Filgrastim (Neupogen)

Correct Answer is B

Explanation

A. Oprelvekin (Neumega): Oprelvekin is a recombinant human interleukin-11 (IL-11) used to stimulate the production of platelets, not red blood cells. It is primarily indicated for patients with thrombocytopenia (low platelet count) due to chemotherapy.

B. Epoetin alfa (Procrit): Epoetin alfa is a synthetic form of erythropoietin, a hormone produced by the kidneys that stimulates the production of red blood cells in the bone marrow. It is commonly used to treat anemia associated with chronic kidney disease, chemotherapy, or HIV therapy. Therefore, it is administered to increase the number of circulating red blood cells.

C. Clopidogrel (Plavix): Clopidogrel is an antiplatelet medication that inhibits platelet aggregation, thereby reducing the risk of blood clots. It does not directly stimulate the production of red blood cells.

D. Filgrastim (Neupogen): Filgrastim is a recombinant human granulocyte colony-stimulating factor (G-CSF) that stimulates the production of white blood cells, particularly neutrophils, in the bone marrow. It is used to treat neutropenia (low white blood cell count) caused by chemotherapy, bone marrow transplantation, or certain diseases. It does not directly stimulate the production of red blood cells.

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A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider?

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