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?

Choice A rationale

Alendronate is a bisphosphonate medication used to treat osteoporosis. It is known to be highly irritating to the esophageal mucosa, and if it lodges in the esophagus, it can cause severe esophagitis, ulceration, or erosion. Assessing the client's ability to swallow ensures safe passage of the medication and minimizes the risk of esophageal injury, highlighting a critical safety measure.

Choice B rationale

Alendronate should not be administered before bed. For optimal absorption and to minimize the risk of esophageal irritation, alendronate must be taken in the morning upon waking, at least 30 minutes before the first food, beverage, or medication. Taking it before bed increases the likelihood of the pill lingering in the esophagus, leading to irritation and potential injury.

Choice C rationale

Alendronate should not be administered with orange juice. The absorption of alendronate is significantly impaired by food, beverages other than plain water, and certain minerals like calcium. Orange juice contains calcium and can decrease the bioavailability of the medication, thereby reducing its therapeutic effectiveness. It must be taken with plain water only.

Choice D rationale

Informing the client to remain supine after taking the medication is incorrect. To facilitate rapid transit to the stomach and minimize esophageal contact, clients must remain upright (sitting or standing) for at least 30 minutes after taking alendronate, and until after their first food of the day. Lying down increases the risk of esophageal reflux and irritation.

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.