A nurse is reviewing the laboratory results for a client who is taking warfarin following orthopedic surgery.
Which of the following results should the nurse report to the provider?
PT 15.5 seconds (11 to 12.5 seconds).
aPTT 45 seconds (30 to 40 seconds).
INR 5.2 (0.8 to 1.1).
Platelet count 90,000/mcL (150,000 to 400,000/mcL).
The Correct Answer is C
Choice A rationale
A prothrombin time (PT) of 15.5 seconds, while slightly above the normal range of 11 to 12.5 seconds, indicates a mild prolongation of clotting time. For a client on warfarin, a slight elevation in PT is often expected as it reflects the anticoagulant effect. This value alone may not necessitate immediate reporting.
Choice B rationale
An activated partial thromboplastin time (aPTT) of 45 seconds, slightly above the normal range of 30 to 40 seconds, indicates a minor prolongation in the intrinsic and common pathways of coagulation. While relevant for heparin therapy, its direct significance for warfarin's primary monitoring is less critical.
Choice C rationale
An International Normalized Ratio (INR) of 5.2 is significantly elevated above the therapeutic range for most conditions, which is typically 2.0 to 3.0 for clients on warfarin. An INR of 5.2 indicates a high risk of bleeding complications due to excessive anticoagulation, requiring immediate provider notification. Normal range is 0.8 to 1.1.
Choice D rationale
A platelet count of 90,000/mcL is below the normal range of 150,000 to 400,000/mcL, indicating thrombocytopenia. While important for hemostasis, warfarin primarily affects clotting factors, not platelet production. However, a low platelet count combined with high INR further increases bleeding risk, necessitating reporting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Cromolyn is a mast cell stabilizer that works by inhibiting the release of inflammatory mediators like histamine from mast cells. This prophylactic action requires consistent, daily use to build up therapeutic levels and prevent the initiation of the asthmatic response, rather than acting as a rescue medication during an acute attack.
Choice B rationale
Using cromolyn as soon as one feels like wheezing is incorrect because cromolyn is not a bronchodilator and does not provide immediate relief for acute bronchospasm. Its mechanism of action involves stabilizing mast cells, which prevents the degranulation and release of inflammatory mediators, thus preventing symptoms from occurring.
Choice C rationale
Expecting to feel better in a week is an inappropriate timeframe for assessing cromolyn's efficacy. The full prophylactic benefits of cromolyn may take several weeks of consistent use to become apparent. Patients should be educated on the preventative nature and delayed onset of action.
Choice D rationale
While cromolyn can be used prophylactically before exercise, using it 2 hours before playing softball is not the recommended timing. For exercise-induced bronchospasm, cromolyn is typically administered 15 to 30 minutes prior to the activity to allow for adequate absorption and mast cell stabilization before exertion.
Correct Answer is ["3"]
Explanation
Step 1 is: Convert client weight from pounds to kilograms. 165 Ib ÷ 2.2 Ib/kg = 75 kg.
Step 2 is: Calculate the total dose of verapamil needed. 0.1 mg/kg × 75 kg = 7.5 mg.
Step 3 is: Calculate the volume to administer in mL. 7.5 mg ÷ (2.5 mg/mL) = 3 mL. The nurse should administer 3 mL.
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