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 : Keeping the client in a high-Fowler's position for 6 hours post-cardiac catheterization is not recommended. After a femoral approach, it's important to keep the leg straight and the patient flat or with the head slightly elevated to prevent bleeding from the catheter insertion site. High-Fowler's position could increase the risk of bleeding and is not conducive to maintaining pressure at the arterial access site.

Choice B reason : Allowing the patient to ambulate around the room immediately after the procedure is contraindicated. The patient is typically required to remain on bed rest with the affected leg straight to prevent bleeding and ensure proper healing of the arterial puncture site. Ambulation is usually restricted for several hours post-procedure.

Choice C reason : Checking pedal pulses every 15 minutes is a critical action following cardiac catheterization via the femoral artery. It ensures that there is adequate blood flow to the extremity and helps to identify any complications such as occlusion or bleeding early. Adequate perfusion is indicated by strong and equal pedal pulses.

Choice D reason : Performing passive range-of-motion exercises for the affected extremity immediately after cardiac catheterization is not recommended. The affected leg should remain straight without bending at the hip to prevent bleeding from the catheter site. Passive range-of-motion could disrupt the vascular integrity at the puncture site and increase the risk of bleeding.

A. Low sodium diet B. Serum cardiac enzyme levels C. MRI of the chest D. Physical therapy

Correct Answer is C

Explanation

Choice A reason : A low sodium diet is often prescribed for patients with heart conditions to help manage blood pressure and fluid retention. It is not typically something that would need to be questioned in the context of recent pacemaker surgery.

Choice B reason : Checking serum cardiac enzyme levels is a common practice after heart surgery to monitor for any signs of damage to the heart muscle. This would not typically be questioned unless there were specific contraindications for the patient.

Choice C reason : An MRI of the chest should be questioned because MRI machines use strong magnetic fields that can interfere with the functioning of a pacemaker. Unless the pacemaker is specifically labeled as MRI-safe, this type of imaging could be dangerous for the patient.

Choice D reason : Physical therapy is a standard part of recovery after many types of surgery, including pacemaker insertion, to help the patient regain strength and mobility. It would not typically be questioned unless the patient had specific restrictions.

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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?

Nursing Test Bank

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