A nurse is reviewing the medical record of a client who is to undergo open heart surgery. Which of the following findings should the nurse report to the provider as a contraindication to receiving heparin?

COPD

Thalassemia

Thrombocytopenia

Rheumatoid arthritis

Answer and Explanation

The Correct Answer is C

Choice A Reason:

COPD (Chronic Obstructive Pulmonary Disease) - While COPD might influence the choice of anaesthesia and perioperative management, it is not a direct contraindication to heparin.

Choice B Reason:

Thalassemia - Thalassemia is a genetic blood disorder that affects haemoglobin production and the structure of red blood cells. It does not directly impact the ability to receive heparin.

Choice C Reason:

Thrombocytopenia. Thrombocytopenia, which is a low platelet count, is a contraindication to receiving heparin, an anticoagulant. Heparin works by preventing the formation of blood clots, but if a person has a low platelet count, their ability to form blood clots is already compromised. Administering heparin in this situation could increase the risk of bleeding and further reduce platelet count.

Choice D Reason:

Rheumatoid arthritis - Rheumatoid arthritis is an autoimmune condition affecting joints. It is not a contraindication to heparin use, but the client's overall health and medications should be considered when planning surgery and anticoagulant therapy.

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Correct Answer is A

Explanation

A. Inability to exhale retained carbon dioxide: During an acute asthma attack, airway obstruction due to bronchospasm, inflammation, and increased mucus production leads to air trapping. This makes it difficult for the client to fully exhale, resulting in the retention of carbon dioxide. Hyperinflation of the lungs and respiratory acidosis can occur as a result, contributing to the client's manifestations.

B. Acute loss of alveolar elasticity: A loss of alveolar elasticity is associated with conditions like emphysema, not asthma. Asthma primarily affects the airways rather than the alveoli, and elasticity is not typically impacted during an acute asthma attack.

C. Decreased responsiveness of airways to allergens: Asthma is characterized by increased responsiveness of the airways to triggers such as allergens, not decreased responsiveness. This hyperresponsiveness is a hallmark of the condition and contributes to airway narrowing during an attack.

D. Suppressed bronchiolar inflammatory response: Asthma attacks involve heightened inflammation of the bronchioles, not a suppressed inflammatory response. The inflammation contributes to airway swelling, increased mucus production, and bronchospasm.

A. Calcium level 11,5 mg/dl B. Serum albumin level 3.9 g/dL C. Output 200 ml, more than intake over the past 12 hr. D. Fasting blood glucose level 105 mg/dL

Correct Answer is A

Explanation

Choice A reason:

A calcium level of 11.5 mg/dL is elevated. Normal calcium levels typically range from 8.5 to 10.5 mg/dL. Hypercalcemia can lead to various complications, including cardiac arrhythmias and neurological symptoms. The nurse should notify the provider of this finding for further evaluation and management.

Choice B reason

Serum albumin level 3.9 g/dL is not appropriate. This level is within a reasonable range for serum albumin. It might be an indicator of nutritional status, but it's not an urgent concern.

Choice C reason:

Output exceeding intake over a 12-hour period may indicate fluid imbalance or inadequate intake compared to output. However, without further context, such as the client's overall fluid status, this finding alone may not be alarming. The nurse should assess the client's hydration status, consider potential causes of increased output, and address any concerns accordingly. While the nurse may need to monitor closely and address any potential issues, immediate notification of the provider may not be necessary based solely on this finding.

Choice D reason:

Fasting blood glucose level 105 mg/dL is not appropriate: A fasting blood glucose level of 105 mg/dL is slightly elevated, but it's not a critically high value. The nurse should monitor blood glucose levels and collaborate with the healthcare team to manage blood glucose appropriately.

However, if the client has a history of diabetes or if there are other concerning factors, such as consistent high glucose levels or symptoms of hyperglycemia, the nurse may need to monitor closely and notify the provider for further evaluation and management. Otherwise, this finding alone may not warrant immediate notification.

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A nurse is reviewing the medical record of a client who is to undergo open heart surgery. Which of the following findings should the nurse report to the provider as a contraindication to receiving heparin?

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