The nurse is reviewing laboratory values for a client receiving a continuous heparin infusion. Which of the following laboratory values should the nurse monitor?

AST and ALT

Prothrombin time (PT)

Activated partial thromboplastin time (aPTT)

International normalized ratio (INR)

Answer and Explanation

The Correct Answer is C

A. AST and ALT are liver enzymes, primarily used to assess liver function, not directly related to monitoring heparin therapy.

B. Prothrombin time (PT) is used to monitor warfarin therapy, not heparin. Heparin therapy is typically monitored with aPTT, whereas warfarin is monitored with PT/INR.

C. Heparin is an anticoagulant that works by inhibiting clotting factors, and the aPTT is used to monitor its effectiveness. The aPTT measures the time it takes for blood to clot and helps ensure the heparin dose is therapeutic without causing excessive bleeding. The typical therapeutic range for aPTT on heparin therapy is 1.5 to 2.5 times the normal value.

D. INR is used to monitor warfarin therapy, not heparin. Heparin does not affect INR levels.

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Correct Answer is A

Explanation

A. Troponins (specifically troponin I and T) are proteins released when the heart muscle is damaged. They are the most specific and sensitive markers for myocardial injury, especially in diagnosing a myocardial infarction (MI).

B. Creatine kinase (CK) is an enzyme found in various tissues, including the heart. CK-MB is a cardiac isoenzyme, but it is not as specific for myocardial injury as troponins. It can also be elevated in other conditions like muscle injury.

C. Homocysteine (Hcy) is an amino acid that can increase the risk of cardiovascular disease but does not serve as an immediate marker for myocardial damage.

D. Myoglobin is an early marker of muscle injury, but it lacks specificity for myocardial damage as it can also rise in skeletal muscle injury, making it less reliable than troponins.

A. Troponin level B. Electrocardiogram (ECG) C. Insertion of a peripheral IV D. Chest X-ray

Correct Answer is B

Explanation

A. A troponin level will confirm myocardial injury but should be done after an ECG, as the ECG provides immediate information on the condition.

B. The first action in a chest pain situation is to obtain an ECG to assess for myocardial infarction or other cardiac abnormalities. The ECG provides immediate information about the heart's electrical activity and can help identify whether the chest pain is related to a cardiac event.

C. Insertion of a peripheral IV is important for administering medications and fluids, but it is not as urgent as obtaining an ECG to evaluate the patient's heart.

D. A chest X-ray is useful for other potential diagnoses (e.g., pulmonary embolism or pneumothorax) but is not the first step in diagnosing a myocardial event.

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The nurse is reviewing laboratory values for a client receiving a continuous heparin infusion. Which of the following laboratory values should the nurse monitor?

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