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 D

Explanation

Choice A reason : Morphine is an opioid analgesic used to relieve severe pain and can be administered to patients with myocardial infarction to alleviate chest pain and anxiety. However, it is not the first medication given as it does not address the underlying cause of the myocardial infarction, which is the formation of a blood clot in the coronary arteries.

Choice B reason : Nitroglycerin is a nitrate that helps to dilate blood vessels and improve blood flow. It can be used to relieve chest pain in myocardial infarction, but similar to morphine, it is not the initial medication of choice. The priority is to prevent further blood clotting.

Choice C reason : Administered as soon as possible to inhibit platelet aggregation and reduce clot progression.

Choice D reason : When a myocardial infarction (MI) is suspected, the priority is to address tissue hypoxia and ensure adequate oxygenation to minimize myocardial damage. Administering oxygen helps increase oxygen availability to the ischemic heart tissue, reducing further damage.

A. 2.0-3.0 B. 4.0-5.0 C. 1.0-2.0 D. 3.0-4.9

Correct Answer is A

Explanation

Choice A reason : The therapeutic INR range for a patient on Warfarin, especially for conditions such as atrial fibrillation, venous thromboembolism, and for the prevention of thrombosis in patients with prosthetic heart valves, is typically 2.0-3.0. This range balances the risk of clotting with the risk of bleeding. An INR of 2.0-3.0 means that the blood is taking twice to three times as long as normal blood to clot, which is the desired effect of the medication in preventing harmful clots.

Choice B reason : An INR range of 4.0-5.0 is generally considered too high for most therapeutic purposes and increases the risk of bleeding complications. This range might be appropriate in very specific clinical situations, such as for patients with mechanical heart valves who may require a slightly higher INR, but it is not the standard therapeutic range.

Choice C reason : An INR range of 1.0-2.0 is below the therapeutic range for patients on Warfarin. This range would not provide sufficient anticoagulation and would leave the patient at risk for thrombotic events.

Choice D reason : An INR range of 3.0-4.9 is higher than the standard therapeutic range and could lead to an increased risk of bleeding. While some patients with mechanical heart valves in the mitral position may require an INR up to 3.5, an INR higher than this is usually not necessary and could be dangerous.

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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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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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