Which plasma lipoprotein level is most concerning when considering the risk of coronary atherosclerosis?

Choice A reason:
Holding the heparin and notifying the provider is the appropriate action. The significant drop in platelet count suggests the possibility of heparin-induced thrombocytopenia (HIT), a serious complication of heparin therapy. Immediate discontinuation of heparin and further evaluation are necessary to manage this condition.

Choice B reason:
Requesting an order for vitamin K (phytonadione) is not appropriate in this scenario. Vitamin K is used to reverse the effects of warfarin, not heparin. The issue here is the potential for HIT, not an over-anticoagulation that requires vitamin K.

Choice C reason:
While requesting a PTT test is part of managing anticoagulation therapy, it is not the immediate priority in this case. The significant drop in platelet count is more concerning for HIT, which requires stopping heparin and notifying the provider for further evaluation.

Choice D reason:
Administering oxygen and notifying the provider is not specific to managing the issue of a significantly low platelet count in a patient on heparin. The primary concern here is the potential for HIT, which necessitates stopping the heparin.

Choice A reason:
Loss of muscle tone at the lower esophageal sphincter (LES) is the primary cause of GERD. The LES normally prevents stomach contents from refluxing into the esophagus. When its tone is reduced, acidic gastric contents can flow back, leading to symptoms such as heartburn, regurgitation, and potential damage to the esophageal lining. Factors contributing to LES dysfunction include obesity, hiatal hernia, and certain dietary habits.
Choice B reason:
Sympathetic nerve stimulation is not a cause of GERD. The autonomic nervous system plays a role in regulating digestive functions, but GERD is primarily a mechanical issue involving the LES and is not directly related to sympathetic nervous activity.
Choice C reason:
Fibrosis of the lower third of the esophagus is typically associated with conditions such as scleroderma, which can lead to esophageal motility disorders. While fibrosis might contribute to esophageal dysfunction, it is not the primary cause of GERD.
Choice D reason:
Reverse peristalsis of the stomach is not a mechanism for GERD. GERD results from dysfunction of the LES, not from the backward movement of stomach contents due to altered motility.