A nurse is collecting data from a client who is taking heparin to prevent deep-vein thrombosis and has bloody stools. Which of the following laboratory values should the nurse report to the provider?

Platelets 200,000/mm3

RBC count 5.4 million/mm2

Hgb 14 g/dL

INR 5.2

Answer and Explanation

The Correct Answer is D

A.   Platelets within the normal range indicate appropriate clotting function and are not concerning in this scenario.
B.   Red blood cell (RBC) count within the normal range suggests normal oxygen-carrying capacity and is not directly related to the client's symptoms.
C.   Hemoglobin (Hgb) level within the normal range indicates adequate oxygen-carrying capacity and is not directly related to the client's symptoms.
D.   An international normalized ratio (INR) of 5.2 is significantly elevated and indicates that the client's blood is not clotting properly. This could be a result of excessive anticoagulation from heparin therapy, which may lead to bleeding complications such as bloody stools. Therefore, the nurse should report this finding to the provider for further evaluation and possible adjustment of the anticoagulant therapy.

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Correct Answer is A

Explanation

A. A client who has a new onset of chest pain requires immediate assessment and intervention by an RN or healthcare provider with appropriate training and licensure due to the potential seriousness of the condition. Assessing and managing chest pain typically involves performing an ECG, administering medications, and coordinating further diagnostic tests or interventions, which are typically within the scope of practice of an RN or higher.
B. A client who has a tracheostomy may require routine tracheostomy care and suctioning, which are within the scope of practice of an LPN under the supervision of an RN or healthcare provider.
C. A client who is receiving enteral feedings may require monitoring of feeding tube placement, administration of enteral feedings, and assessment for complications related to enteral nutrition, which are within the scope of practice of an LPN.
D. A client who has urinary retention may require urinary catheterization or bladder scan assessment, which are within the scope of practice of an LPN under the supervision of an RN or healthcare provider.

A. Heart rate 130/min B. ECG monitor showing sinus tachycardia C. edema D. Breathing rapid and shallow. Crackles E. gaining 10 pounds in the past month.

Correct Answer is ["A","B","C","D","E"]

Explanation

Correct answers:

Nurses Notes Day 1, 1600:
Alert and oriented x3. Pupils equal, round, reactive to light, accommodation at 3 mm. Heart rate 150/min, ECG monitor showing sinus tachycardia, 5, auscultated. Lower extremity edema noted, 2+ bilaterally. Radial and pedal pulses 1 bilaterally. Breathing rapid and shallow. Cracklesauscultated in bases bilaterally. Bowel sounds normoactive in all four quadrants. Reports no difficulty urinating.
Client reports gaining "10 pounds in the past month."

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A nurse is collecting data from a client who is taking heparin to prevent deep-vein thrombosis and has bloody stools. Which of the following laboratory values should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

Correct Answer is ["A","B","C","D","E"]

Explanation

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