The nurse is reviewing the lab results of a patient who takes warfarin to prevent deep vein thrombosis. Which laboratory result requires follow up by the nurse?

The partial thromboplastin time is 30 seconds

The International normalized ratio is 6.0

Creatinine is 12

The patient's hematocrit level is 43%

Answer and Explanation

The Correct Answer is B

A. The partial thromboplastin time is 30 seconds:

The partial thromboplastin time (PTT) measures the clotting time of blood and is typically used to monitor patients on heparin therapy, not warfarin. A PTT of 30 seconds is within the normal range and does not directly relate to warfarin therapy. Therefore, it does not require immediate follow-up in the context of warfarin administration.

B. The International normalized ratio is 6.0:

The International Normalized Ratio (INR) is a standard measure used to monitor the effectiveness of warfarin therapy. For most indications, the therapeutic range for INR is typically between 2.0 and 3.0. A value of 6.0 indicates that the patient's blood is taking six times longer to clot than normal, suggesting a significantly increased risk of bleeding. Therefore, this result requires immediate follow-up by the nurse to assess the patient's condition and potentially adjust warfarin dosage to reduce the risk of bleeding.

C. Creatinine is 12:

Creatinine is a waste product generated by muscle metabolism and is filtered out of the blood by the kidneys. Elevated levels of creatinine may indicate impaired kidney function, but this result does not directly relate to warfarin therapy. While an elevated creatinine level may require follow-up for other reasons, it does not necessitate immediate action related to warfarin therapy.

D. The patient's hematocrit level is 43%:

Hematocrit is a measure of the proportion of red blood cells in the blood. A hematocrit level of 43% is within the normal range for both men and women and does not directly relate to warfarin therapy. While changes in hematocrit may occur in some patients taking warfarin, this result alone does not require immediate follow-up in the context of warfarin administration.

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Correct Answer is B

Explanation

A. Apply a heating pad to the lower extremities for pain: Heat application can increase vasodilation and worsen symptoms in patients with peripheral arterial disease (PAD). Therefore, it is not recommended as a pain management strategy for PAD.

B. Always wear soft shoes or slippers when out of bed: This instruction is important for patients with PAD to protect their feet from injury and provide adequate support. Soft shoes or slippers help prevent trauma and pressure ulcers, which are common complications in patients with reduced peripheral circulation.

C. Wear knee-high tight socks: Tight socks can restrict blood flow and exacerbate symptoms in patients with PAD. It is important to encourage patients to wear loose-fitting socks to promote adequate circulation.

D. Put cream or lotion between the toes: Moisture between the toes can increase the risk of fungal infections, which can be particularly problematic in patients with compromised circulation. It is important to keep the feet clean and dry and avoid applying cream or lotion between the toes.

A. Using appropriate personal protective equipment (PPE). B. Placing patient in positive pressure isolation room C. Placing patient in contact precautions D. Wearing gloves at all times.

Correct Answer is A

Explanation

A. Using appropriate personal protective equipment (PPE): Standard precautions include the use of PPE such as gloves, masks, gowns, and eye protection when caring for all patients, regardless of their known or suspected infectious status. This helps prevent the transmission of pathogens between the patient and the healthcare provider.

B. Placing patient in positive pressure isolation room: Placing a patient in a positive pressure isolation room is not a component of standard precautions. Positive pressure rooms are typically used for patients with compromised immune systems to protect them from exposure to airborne pathogens. Standard precautions should be followed regardless of the patient's room type.

C. Placing patient in contact precautions: Contact precautions involve specific measures to prevent the transmission of pathogens through direct or indirect contact with the patient or their environment. While contact precautions may be necessary for certain infectious diseases, they are not a component of standard precautions.

D. Wearing gloves at all times: While wearing gloves is part of standard precautions, it is not the only key element. Standard precautions also include other forms of PPE such as masks, gowns, and eye protection, as well as other infection control practices such as hand hygiene and environmental cleaning.

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