Laboratory Studies

The patient is started on subcutaneous heparin injections 7500 units q12h for deep vein thrombosis prophylaxis at 0900. When does the nurse plan to obtain the activated partial thromboplastin time (aPTT) to determine effectiveness of therapy?  

The patient is receiving a continuous heparin infusion that started at 0000 for the treatment of a deep vein thrombosis in the leg. Prior to the initiation of therapy, the patient’s activated partial thromboplastin time (aPTT) level was 35 seconds. The aPTT level drawn at 0800 was found to be 70 seconds. The nurse reports this information to the provider and advocates for which intervention?  

The patient who was started on warfarin sodium for the treatment of atrial fibrillation has reached steady state with the current dose. Which instruction is most important to give the patient?

The patient’s platelet level is found to be 560,000 mm³. The nurse assesses the patient for which symptoms? Select all that apply.  

The 18-year-old patient in sickle cell crisis has received multiple blood transfusions. During the shift assessment, the nurse notes the patient’s heart rate is 132 bpm, blood pressure is 102/58 mmHg, and the sclera are yellow. Which lab result would be surprising for this patient?  

The 8-year-old male patient presents complaining of warm, painful, swollen joints with decreased range of motion. Upon assessment, he is pale and tachycardic. The parent reports easy bruising and frequent nosebleeds. Which does the nurse most anticipate administering? 

The nurse assessing the 4-month-old brought to the emergency room for poor feeding and signs of dehydration notes the infant seems to be looking down and sclera is visible superior to the iris. The nurse reports this assessment to the provider and receives orders for care. Which order does the nurse question? 

The 8-month-old patient has had 4 skin abscesses in the past 3 months that have required draining. Each abscess drains less than 5 mL non-purulent fluid. The infant appears well otherwise and the parents deny respiratory infections. The infant’s complete blood count shows an elevated white blood cell count without bands or segmented cells. Immunoglobulin levels are appropriate for the age of the infant. The patient has a positive nitroblue test. The nurse plans care to include which intervention? 

The 36-hour-old neonate who was born at 37 weeks gestation to a G3P2 mother has yet to pass meconium. The baby was born by cesarean section due to refractory preeclampsia with severe features. The mother reports the baby has been breastfeeding well after a slow first 12 hours. Upon assessment, the baby appears well with good tone and responsiveness. The baby’s anus is patent and the abdomen is soft and rounded; bowel sounds present. The mother denies emesis in the baby. An abdominal x-ray is obtained, which is normal. The nurse informs the mother that which test will be performed next? 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 34-year-old male patient is brought by ambulance to the emergency department an hour after a witnessed car accident occurred in which he sustained a laceration to his right femoral artery. The paramedics placed a tourniquet and held pressure until arrival to the emergency department, but significant blood loss is estimated. The nurse anticipates the initial complete blood count will reveal which results?  

The 20-year-old student went on a mission trip to Ghana to help at a local hospital. She presented to the clinic 12 days after her return; she began to experience anorexia, flu-like symptoms, and fatigue. Ten days later, she noticed her eyes and skin looked yellow. Her history, assessment, and vitals are within normal limits except her yellow sclera and jaundiced skin. Initial lab studies reveal a total bilirubin of 16, indirect bilirubin of 8, AST of 1320 and ALT of 1400. The nurse prepares the patient for which test next? 

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. The nurse anticipates which finding on the lumbar puncture result?  

The 38-year-old patient who strictly adheres to a vegan diet complains of weakness and tingling in her lower extremities. She retains the strength in her lower extremities but proprioception is decreased.  Her complete blood count revealed a hemoglobin of 10.2 mg/dL, white blood cell count of 9 x 10³ cells/µL, and a mean corpuscular volume of 110. Which information does the nurse provide to the patient?  

The 20-year-old healthy soccer player is brought to the emergency department after collapsing at the end of a summer soccer game. The patient is lethargic and confused about the event. Upon assessment, the nurse notes flushed, dry skin that is warm to the touch. The oral mucosa is dry, as well. Vitals are as follows: temperature 40.7°C, heart rate 122 bpm, respiratory rate 20, and blood pressure 116/64 mmHg. Which lab studies does the nurse obtain? Select all that apply.  

The 2-year-old patient who has a history of drug-induced hemolysis, anemia, and hyperbilirubinemia presents to the clinic complaining of urinary urgency and dysuria. The patient has a fever and the urinalysis is positive for leukocyte esterase as well white blood cell casts. Which medications, if prescribed for the patient, prompt the nurse to clarify with the provider prior to administering them? Select all that apply.  

The patient has been prescribed belatacept for transplant rejection. Which lab result is most important to evaluate prior to administration?

The neonate is found to have a hemoglobin of 26 g/dL on the first day of life. Which additional findings does the nurse anticipate in this patient? Select all that apply.

The patient experiencing an oversecretion of vasopressin presents with a decrease in which laboratory value?