A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider?
Partial thromboplastin time (PTT) 55 seconds
Hematocrit 45%
White blood cell count 8,000/mm³
Platelets 74,000/mm³
The Correct Answer is D
A. Partial thromboplastin time (PTT) 55 seconds: This PTT value is within the therapeutic range for a client on heparin therapy.
B. Hematocrit 45%: This hematocrit value is within normal limits and is not concerning.
C. White blood cell count 8,000/mm³: A WBC count of 8,000/mm³ is within the normal range and does not require reporting.
D. Platelets 74,000/mm³: A low platelet count (thrombocytopenia) can indicate heparin-induced thrombocytopenia (HIT), a potentially serious complication of heparin therapy.
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Correct Answer is C
Explanation
A. S3 heart sounds. An S3 sound is more indicative of heart failure rather than PVCs specifically.
B. Increase in point of maximum impulse (PMI). PMI is typically displaced in conditions like ventricular hypertrophy or heart failure, not PVCs.
C. Irregular pulsations. PVCs are extra beats that interrupt the heart’s normal rhythm, leading to irregular pulsations on palpation.
D. Bradycardia. PVCs usually occur in the context of normal or elevated heart rates rather than bradycardia.
Correct Answer is B
Explanation
A. Obtain a blood sample. Although obtaining a blood sample is essential for cardiac enzyme levels, it is not the highest priority. Addressing oxygenation takes precedence to relieve hypoxia.
B. Initiate oxygen therapy. Oxygen is the first priority to improve oxygenation in a client showing signs of hypoxia (cyanosis, dyspnea), which can prevent further ischemic damage to the heart.
C. Attach the leads for a 12-lead ECG. While obtaining an ECG is essential for diagnosing myocardial ischemia, ensuring oxygenation is more critical in this moment.
D. Insert the IV catheter. An IV line is necessary to administer fluids and medications, but oxygenation should be prioritized first to stabilize the client.