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 A
Explanation
A. Obtain a pair of slipper socks for the client. Slipper socks can provide warmth without applying direct heat, which is safer for clients with impaired circulation.
B. Increase the client's oral fluid intake. Increasing fluids does not directly address cold feet and may be contraindicated depending on the client’s condition.
C. Rub the client's feet briskly for several minutes. Rubbing can damage skin and tissue in clients with poor circulation and should be avoided.
D. Place a moist heating pad under the client's feet. Heating pads can cause burns and further impair circulation in clients with vascular issues.
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.