The nurse evaluates morning laboratory results for several clients who were admitted 24 hours earlier. Which laboratory report requires priority follow-up?

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Clients with pulmonary embolism or deep venous thrombosis are treated with anticoagulation. Unfractionated heparin is one such agent, and its efficacy is measured through partial thromboplastin time (PTT) levels. The goal during anticoagulation therapy is a PTT 1.5-2 times the normal reference range of 25-35 seconds. A PTT of 127 seconds is much too prolonged, and spontaneous bleeding could occur. (Option A) Clients with chronic obstructive pulmonary disease typically have elevated PaCO₂ levels secondary to air trapping. A PaCO₂ of 52 mm Hg (6.9 kPa), although elevated from the normal range of 35-45 mm Hg (4.7-6.0 kPa), is not extreme for this client. (Option B) Clients with heart failure are expected to have elevated brain natriuretic peptide (BNP) levels. The nurse should compare BNP levels with those from the previous day. The client is likely receiving therapy for heart failure and is therefore not a priority. (Option C) A normal white blood cell (WBC) count is 4,000-11,000/mm³ (4.0-11.0 x 10⁹/L). A WBC count of 13,000/mm³ (13.0 x 10⁹/L) is elevated but would be expected in a client with an infection. Even if this is the client's first WBC result, it is not a priority over the client with elevated PTT. Educational objective: Clients who are receiving heparin infusion for pulmonary embolism or deep venous thrombosis should be maintained with a partial thromboplastin time of 1.5-2 times the reference range used by the laboratory measuring the level. The normal reference range is typically 25-35 seconds.

The Nurse Evaluates Morning Laboratory Results for Several Clients Who