A client is on intravenous heparin to treat DVT in the right leg. The client’s most recent partial thromboplastin time (PTT) was 25 seconds. What order would the nurse anticipate?

No change to the heparin rate

Decrease the heparin rate

Stop heparin and start warfarin

Increase the heparin rate

Answer and Explanation

The Correct Answer is D

Choice A reason: No change to the heparin rate is not appropriate in this scenario. The normal range for PTT is generally between 25 to 35 seconds. However, for a client on heparin therapy, the target PTT is typically 1.5 to 2.5 times the normal range, which would be approximately 60 to 80 seconds. Since the client’s PTT is only 25 seconds, it indicates that the blood is clotting too quickly, and the heparin dose is insufficient.

Choice B reason: Decreasing the heparin rate would further reduce the anticoagulant effect, which is not advisable given the current PTT of 25 seconds. Lowering the heparin rate could increase the risk of thrombus formation and worsen the deep vein thrombosis (DVT) condition.

Choice C reason: Stopping heparin and starting warfarin is not an immediate solution. Warfarin takes several days to achieve its full anticoagulant effect, and during this transition period, the client would be at risk of clot formation. Heparin provides immediate anticoagulation, which is crucial in the acute management of DVT.

Choice D reason: Increasing the heparin rate is the correct action. The current PTT of 25 seconds is below the therapeutic range for a client on heparin therapy. Increasing the heparin rate will help achieve the desired anticoagulant effect, prolonging the PTT to the target range of 60 to 80 seconds.

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

Explanation

Choice A Reason:

Weight loss.

Weight loss is a common symptom of hyperthyroidism. This condition speeds up the body’s metabolism, causing the body to burn calories more quickly than usual. Despite an increased appetite, individuals with hyperthyroidism often experience significant weight loss. This symptom is a direct result of the overproduction of thyroid hormones, which increases the metabolic rate.

Choice B Reason:

Intolerance to cold.

Intolerance to cold is not typically associated with hyperthyroidism; it is more commonly a symptom of hypothyroidism. Hyperthyroidism usually causes heat intolerance due to the increased metabolic rate, which raises the body’s temperature. Therefore, this choice is not relevant to hyperthyroidism.

Choice C Reason:

An elevated systolic blood pressure.

An elevated systolic blood pressure can be a symptom of hyperthyroidism. The increased levels of thyroid hormones can cause the heart to work harder, leading to higher blood pressure. This symptom is important to monitor as it can lead to further cardiovascular complications if left untreated.

Choice D Reason:

A heart rate of 90 bpm.

A heart rate of 90 bpm is within the normal range for adults and is not specifically indicative of hyperthyroidism. Hyperthyroidism typically causes a rapid or irregular heartbeat, often exceeding 100 bpm. Therefore, this choice does not accurately reflect a clinical manifestation of hyperthyroidism.

Choice E Reason:

Increased fatigability.

Increased fatigability is a common symptom of hyperthyroidism. Despite the increased metabolic rate, individuals with hyperthyroidism often feel tired and weak. This paradoxical symptom occurs because the body’s systems are overworked and cannot sustain the heightened activity levels, leading to fatigue.

A. Increased serum albumin B. Decreased serum bilirubin C. Decreased serum ammonia D. Decreased serum alanine aminotransferase (ALT)

Correct Answer is C

Explanation

Choice A Reason: Increased Serum Albumin

Increased serum albumin is not a direct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Albumin is a protein made by the liver, and its levels can be affected by liver function. However, lactulose primarily works by reducing ammonia levels in the blood, not by increasing albumin levels. Normal serum albumin levels range from 3.5 to 5.5 grams per deciliter (g/dL). While improved liver function might eventually lead to increased albumin levels, this is not the primary therapeutic effect of lactulose.

Choice B Reason: Decreased Serum Bilirubin

Decreased serum bilirubin is also not a direct indicator of lactulose’s therapeutic effect. Bilirubin is a byproduct of the normal breakdown of red blood cells and is processed by the liver. Elevated bilirubin levels can indicate liver dysfunction, but lactulose’s main role is to reduce ammonia levels, not bilirubin. Normal serum bilirubin levels are typically between 0.1 to 1.2 milligrams per deciliter (mg/dL). While improved liver function might reduce bilirubin levels, this is not the primary goal of lactulose therapy.

Choice C Reason: Decreased Serum Ammonia

Decreased serum ammonia is the correct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Lactulose is used to treat hepatic encephalopathy, a condition caused by high levels of ammonia in the blood due to liver dysfunction. Lactulose works by converting ammonia into ammonium, which is then excreted from the body. Normal serum ammonia levels are less than 50 micromoles per liter (µmol/L) in adults56. A decrease in serum ammonia levels indicates that lactulose is effectively reducing the toxic levels of ammonia in the blood, thereby achieving its desired therapeutic effect.

Choice D Reason: Decreased Serum Alanine Aminotransferase (ALT)

Decreased serum alanine aminotransferase (ALT) is not a direct indicator of lactulose’s therapeutic effect. ALT is an enzyme found in the liver that helps convert proteins into energy for liver cells. Elevated ALT levels can indicate liver damage. Normal ALT levels range from 7 to 56 units per liter (U/L). While improved liver function might reduce ALT levels, lactulose’s primary role is to reduce ammonia levels, not directly affect ALT.

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A client is on intravenous heparin to treat DVT in the right leg. The client’s most recent partial thromboplastin time (PTT) was 25 seconds. What order would the nurse anticipate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply.

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

Explanation

The nurse is caring for a client diagnosed with chronic hepatitis who is receiving the medication lactulose. Which of these laboratory results would indicate the medication is achieving the desired therapeutic effect?

Correct Answer is C

Explanation

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