Progressive Care Nursing Certification (PCCN) Practice Exam

In a patient with a history of chronic atrial fibrillation presenting with left-sided weakness, which lab value excludes them from thrombolytic therapy?

1. Blood pressure

2. History of atrial arrhythmias

3. International normalized ratio (INR)

4. Renal function

The correct answer is: International normalized ratio (INR)

In the context of a patient with chronic atrial fibrillation presenting with left-sided weakness, the most critical lab value that excludes them from thrombolytic therapy is the International Normalized Ratio (INR). This is primarily due to the risk of bleeding associated with thrombolytic therapy, which can be significant in patients with anticoagulation therapy history. Thrombolytic therapy is typically contraindicated if the INR is greater than 1.7, as this indicates an increased risk of hemorrhagic complications. In patients with atrial fibrillation, anticoagulation is often used to prevent thromboembolic events, which may elevate the INR if the patient has been on warfarin or similar agents. Therefore, a high INR serves as a critical parameter for determining the safety of thrombolytics. Other factors like blood pressure, history of atrial arrhythmias, and renal function can be relevant in assessing overall patient stability and treatment options but do not directly preclude the use of thrombolytic therapy in the same way that an elevated INR does. Thus, it is the INR that plays a key role in the decision-making process regarding the administration of thrombolytics in this scenario.