A nurse on a telemetry unit is reviewing the laboratory results for a client who has atrial fibrillation and is taking warfarin. Which of the following laboratory values should the nurse report to the provider?

Hemoglobin (Hgb) : 16 g/dL

Prothrombin Time (PT) : 45 seconds

Activated Partial Thromboplastin Time (aPTT) : 36 seconds

Platelets : 190,000/mm

Answer and Explanation

The Correct Answer is B

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.

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Correct Answer is C

Explanation

Choice A reason : Advising a client with PVD not to go barefoot is correct. Going barefoot can increase the risk of injury to the feet, which can be particularly dangerous in individuals with PVD due to poor circulation. Any injuries to the feet may heal poorly and can lead to complications such as ulcers or infections.

Choice B reason : Using a thermometer to check the temperature of bath water is a recommended practice for clients with PVD. Due to potential nerve damage and reduced sensation in the extremities, clients may not accurately gauge water temperature, leading to burns. Therefore, using a thermometer helps prevent thermal injury.

Choice C reason : Wearing stockings with elastic tops is not recommended for clients with PVD. Elastic tops can constrict blood flow in the legs, exacerbating circulation problems. Instead, clients should wear non-constricting, well-fitting socks or stockings that promote blood flow.

Choice D reason : Avoiding crossing legs at the knees is good advice for clients with PVD. Crossing the legs can restrict blood flow to the lower extremities, which is already compromised in PVD. Keeping the legs uncrossed and elevating them when possible can help improve circulation.

A. The PR intervals are 0.15 second. B. The QT interval is equal to the R-R interval. C. The QRS intervals are 0.08 second. D. The ST segment is above the isoelectric line.

Correct Answer is D

Explanation

Choice A reason: The PR interval, which is the time from the onset of atrial depolarization (beginning of the P wave) to the onset of ventricular depolarization (beginning of the QRS complex), normally ranges from 0.12 to 0.20 seconds. A PR interval of 0.15 second is within the normal range and does not indicate an acute myocardial infarction.

Choice B reason: The QT interval represents the total time for ventricular depolarization and repolarization. The normal QT interval varies based on heart rate and gender but is typically less than half of the R-R interval in a normal heart rhythm. Therefore, a QT interval equal to the R-R interval is abnormally prolonged, which may suggest other conditions but is not a specific indicator of acute myocardial infarction.

Choice C reason: The QRS complex reflects ventricular depolarization and normally ranges from 0.06 to 0.10 seconds. A QRS interval of 0.08 second is within the normal range and does not suggest an acute myocardial infarction.

Choice D reason: ST segment elevation is a critical finding in the diagnosis of acute myocardial infarction. The ST segment should be at the isoelectric line; elevation above this line is indicative of myocardial injury and is a key diagnostic criterion for ST-elevation myocardial infarction (STEMI). An elevated ST segment is often seen in the early stages of an acute myocardial infarction and requires immediate medical attention.

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A nurse on a telemetry unit is reviewing the laboratory results for a client who has atrial fibrillation and is taking warfarin. Which of the following laboratory values should the nurse report to the provider?

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