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Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 011 (edited file)"Laboratory Values" 10/14/08, Page 1 of 13, 0 Figure(s), 7 Table(s), 1 Box(es)

11: Laboratory Values


PRACTICE QUESTIONS
1. A nurse is reviewing the laboratory results of an adult client with Addisons disease. The nurse determines that the magnesium level is normal if which of the following is noted? 1. 2.0 mg/dL 2. 3.0 mg/dL 3. 4.0 mg/dL 4. 5.0 mg/dL Answer: 1 Rationale: The normal magnesium level in an adult client is 1.6 to 2.6 mg/dL. Options 2, 3, and 4 indicate elevated values. Test-Taking Strategy: Knowledge regarding the normal magnesium level in an adult client is required to answer this question. Remember that the normal magnesium level in an adult client is 1.6 to 2.6 mg/dL. Review this section if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 752. 2. A client is suspected of having a myocardial infarction. The nurse would expect elevations in which isoenzyme value reported with the creatine kinase (CK) level? 1. MM 2. MB 3. BB 4. MK Answer: 2 Rationale: CK is a cellular enzyme that can be fractionated into three isoenzymes. The MM band reflects CK from skeletal muscle. The MB band reflects CK from cardiac muscle, which is the level that increases with myocardial infarction. The BB band reflects CK from the brain. There is no MK band. Test-Taking Strategy: Focus on the key words, myocardial infarction. Recalling that the MB band reflects CK from cardiac muscle will direct you to the correct option. Review this information if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills References: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 428. Pagana, K., & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, pp. 302, 307.

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3. An adult male client has had laboratory work done as part of a routine physical examination. The nurse reviews the clients record and determines that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is found? 1. 0.6 mg/dL 2. 1.1 mg/dL 3. 1.9 mg/dL 4. 3.5 mg/dL Answer: 3 Rationale: The normal serum creatinine level is 0.6 to 1.3 mg/dL. The client with a mild degree of renal insufficiency would have a slightly elevated level, which would be the value of 1.9 mg/dL. Creatinine levels of 3.5 mg/dL may be associated with acute or chronic renal failure. Test-Taking Strategy: Note the key word, mild. This tells you that the correct option will be an abnormal value, but perhaps not the most abnormal of all the options. Use your knowledge of the normal serum creatinine level to direct you to option 3. Review the normal value of this laboratory test if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, pp. 308-309. 4. A client with a seizure disorder is taking phenytoin (Dilantin). A sample for a serum dilantin level is drawn and the nurse determines that the medication therapy is effective if the laboratory result is: 1. 3 g/mL 2. 8 g/mL 3. 16 g/mL 4. 24 g/mL Answer: 3 Rationale: The therapeutic range for serum phenytoin (Dilantin) level is 10 to 20 g/ml. If the level is below the therapeutic range, the client may continue to experience seizure activity. If the level is too high, the client could experience phenytoin toxicity. Test-Taking Strategy: Focus on the issue, that medication therapy is effective. Remember that the therapeutic range for serum phenytoin (Dilantin) level is 10 to 20 g/mL. Review this normal range if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Fundamental Skills Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 2307. 5. A client who takes theophylline for chronic obstructive pulmonary disease (COPD) is seen in the urgent care center for respiratory distress. Just before initiating treatment for the respiratory

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distress, a sample for a theophylline level is drawn. The nurse determines that the client may not be compliant with medication therapy if the result is: 1. 6 g/mL 2. 11 g/mL 3. 15 g/mL 4. 18 g/mL Answer: 1 Rationale: The therapeutic range for the serum theophylline level is 10 to 20 g/mL. If the level is below the therapeutic range, the client may experience frequent exacerbations of the disorder. If the level is within the therapeutic range, the client is most likely compliant with medication therapy. Test-Taking Strategy: Note the key words, may not be compliant. Recalling the therapeutic level of theophylline will direct you to option 1. Review this therapeutic range if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Fundamental Skills Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 53. 6. A nurse is told that the laboratory result for the serum digoxin level is 2.4 ng/mL. The nurse plans to do which of the following? 1. Record the normal value on the clients flow sheet. 2. Administer the next dose of the medication as scheduled. 3. Check the clients last pulse rate. 4. Hold the medication. Answer: 4 Rationale: The normal therapeutic range for digoxin is 0.5 to 2.0 ng/mL. A value of 2.4 ng/mL exceeds the therapeutic range and could be toxic to the client. The nursing action is to hold further doses of digoxin. Option 1 is incorrect because the value is not normal. The next dose should not be administered automatically. Checking the clients pulse is not incorrect but may have limited value. Depending on the time that has elapsed since the last pulse check, it may be more useful to do a current assessment of the clients status. Test-Taking Strategy: Recall that the normal therapeutic range for digoxin is 0.5 to 2.0 ng/mL. Noting that the value is high will direct you to option 4. Review this therapeutic level if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 326. 7. A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium (Coumadin) has a prothrombin time (PT) of 30 seconds. The nurse anticipates that which of the

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following will be prescribed? 1. Holding the next dose of warfarin sodium 2. Administering the next dose of warfarin sodium 3. Increasing the next dose of warfarin sodium 4. Adding a dose of heparin Answer: 1 Rationale: The normal PT is 9.6 to 11.8 seconds (adult male) and 9.5 to 11.3 seconds (adult female). Because the value stated is extremely high (and perhaps near the critical range), the nurse should anticipate that the client would not receive further doses at this time. If the level were too high, then the antidote (vitamin K) may be prescribed. Test-Taking Strategy: Note that the PT is 30 seconds. Noting that the PT value is high will direct you to option 1. Review this section if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, pp. 730-731. 8. An adult client who has had preadmission testing before surgery has had blood drawn for determination of serum electrolyte levels. The nurse identifies which of the following as an abnormal value? 1. Sodium, 148 mEq/L 2. Potassium, 3.8 mEq/L 3. Chloride, 101 mEq/L 4. Bicarbonate, 26 mEq/L Answer: 1 Rationale: The normal serum electrolyte ranges for adults are as follows: sodium, 135 to 145 mEq/L; potassium, 3.5 to 5.1 mEq/L; chloride, 98 to 107 mEq/L; bicarbonate (venous), 22 to 29 mEq/L. The only abnormal value identified is the serum sodium level. Test-Taking Strategy: Focus on the issue, an abnormal value. Recalling the normal serum electrolyte values will direct you to option 1. Review the normal electrolyte values if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 492. 9. An adult client with a critically high potassium level has received sodium polystyrene sulfonate (Kayexalate). The nurse determines that the medication was most effective if the clients repeat serum potassium level is: 1. 6.2 mEq/L 2. 5.8 mEq/ L 3. 5.4 mEq/L

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4. 4.9 mEq/L Answer: 4 Rationale: The normal serum potassium level in the adult is 3.5 to 5.1 mEq/L. Option 4 is the only option reflecting a value that has dropped down into the normal range. Test-Taking Strategy: Note the key words, critically high. You would expect that this medication is administered to lower the potassium level. Recalling the normal serum potassium level will direct you to option 4. Review this normal level if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 887. 10. The adult client with a history of cardiac disease is due for a morning dose of furosemide (Lasix). The nurse reviews the clients record and would report which of the following serum potassium levels before administering the dose of furosemide? 1. 3.2 mEq/L 2. 3.8 mEq/L 3. 4.2 mEq/L 4. 4.8 mEq/L Answer: 1 Rationale: The normal adult serum potassium level is 3.5 to 5.1 mEq/L. Option 2 is the only value that falls below the therapeutic range. Administering furosemide to a client with a low potassium level and a cardiac history could precipitate ventricular dysrhythmias in the client. Test-Taking Strategy: Use the process of elimination. Recalling the normal serum potassium level will assist you in identifying the value that is not within normal range. This will direct you to option 1. Review the normal adult serum potassium level if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 887. 11. A client with diabetes mellitus has a sample for fasting blood glucose drawn. The nurse identifies which of the following results as a critical value? 1. 150 mg/dL 2. 200 mg/dL 3. 220 mg/dL 4. 340 mg/dL Answer: 4 Rationale: The normal fasting blood glucose is 70 to 110 mg/dL in the adult client. A critical level is considered to be one that exceeds 300 mg/dL. This makes option 4 the correct option.

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Test-Taking Strategy: Use the process of elimination and knowledge of the normal fasting blood glucose level to answer the question. Noting the key words critical value will direct you to option 4. Review this laboratory test if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 599. 12. An adult client with a history of gastrointestinal bleeding has a platelet count of 300,000 cells/L. Which of the following actions by the nurse is most appropriate on reading this report? 1. Report the abnormally low count. 2. Report the abnormally high count. 3. Place the client on bleeding precautions. 4. Place the normal report in the clients medical record. Answer: 4 Rationale: A normal platelet count ranges from 150,000 to 400,000 cells/L. The nurse should place the report containing the normal laboratory value into the clients medical record. Test-Taking Strategy: Use the process of elimination. Remember that options that are similar are not likely to be correct. With this in mind, eliminate options 1 and 3 first. From the remaining options, recalling the normal range for this laboratory test will direct you to option 4. Review this normal value if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 879. 13. An adult client with hepatic cirrhosis has been taking a diet with optimal amounts of protein, because neither excess nor deficiency of protein has been helpful. The nurse evaluates the clients status as most satisfactory if the total protein level is which of the following values in the normal range? 1. 0.4 g/dL 2. 3.7 g/dL 3. 6.4 g/dL 4. 9.8 g/dL Answer: 3 Rationale: The normal range for the protein level in the adult client is 6.0 to 8.0 g/dL, making option 3 the correct option. Options 1 and 2 indicate low levels. Option 4 indicates an elevated level. Test-Taking Strategy: Note the key words, most satisfactory. Recalling the normal protein level will direct you to option 3. Review this normal level if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity

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Integrated Process: Nursing Process/Evaluation Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 907. 14. A client is seen in the urgent care center for complaints of chest pain 3 days ago. Since that time, the client has not been feeling well and fatigues easily. The nurse reviews the results of the laboratory tests and suspects myocardial infarction at the time of chest pain 3 days ago if which of the following isoenzymes for lactic dehydrogenase (LDH) comes back positive? 1. LDH1 2. LDH3 3. LDH4 4. LDH5 Answer: 1 Rationale: The isoenzymes that are particularly affected in acute myocardial infarction are LDH1 and LDH2. The LDH level begins to increase approximately 24 hours after myocardial infarction and peaks in 48 to 72 hours. Thereafter, it returns to normal, usually within 7 to 14 days. Test-Taking Strategy: Familiarity with the cardiac isoenzymes for LDH is needed to answer this question. Remember that the isoenzymes that are particularly affected with acute myocardial infarction are LDH1 and LDH2. Review these enzymes if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 710. 15. An adult client was diagnosed with acute pancreatitis 9 days ago. The nurse interprets that the client is recovering from this episode if the serum lipase level drops to which of the following values, which is just beneath the upper limit of normal? 1. 20 U/L 2. 80 U/L 3. 135 U/L 4. 250 U/L Answer: 3 Rationale: The normal serum lipase level is 10 to 140 U/L. The client who is recovering from acute pancreatitis usually has elevated lipase levels for approximately 10 days after onset of symptoms. This makes lipase a valuable test in monitoring the clients pancreatic function. Option 3 is the only option that contains a value just beneath the upper limit of normal. Test-Taking Strategy: Note the key words, just beneath the upper limit of normal. Recalling the normal lipase level will direct you to option 3. Review this normal level if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation

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Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 724. 16. A client arrives in the emergency room complaining of chest pain that began 4 hours ago. A troponin T blood specimen is obtained, and the results indicate a level of 0.6 ng/mL. The nurse interprets that this result indicates: 1. A normal level 2. A level that indicates the presence of possible angina 3. A low value indicating possible gastritis 4. A level that indicates a myocardial infarction Answer: 4 Rationale: Troponin is a regulatory protein found in striated muscle. The troponins function together in the contractile apparatus for striated muscle in skeletal muscle and in the myocardium. Increased amounts of troponins are released into the bloodstream when an infarction causes damage to the myocardium. A troponin T level that is higher than 0.1 to 0.2 ng/mL is consistent with a myocardial infarction. A normal troponin I level is lower than 0.6 ng/mL, whereas a level higher than 1.5 ng/mL is consistent with a myocardial infarction. Test-Taking Strategy: Note that the issue of the question relates to the troponin T level. Recalling that a level higher than 0.1 to 0.2 ng/mL is consistent with a myocardial infarction will direct you to option 4. Review this diagnostic test if you are unfamiliar with it. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Adult Health/Cardiovascular Reference: Malarkey, L., & McMorrow, M. (2005). Nursing guide to laboratory and diagnostic tests. Philadelphia: W.B. Saunders, pp. 179-181. 17. An adult female client has a hemoglobin level of 10.8 g/dL. The nurse interprets that this result is most likely due to which of the following factors in the clients history? 1. Chronic obstructive pulmonary disease (COPD) 2. Heart failure 3. Dehydration 4. Iron deficiency anemia Answer: 4 Rationale: The normal hemoglobin level for an adult female client is 12 to 15 g/dL. Iron deficiency anemia can result in lower hemoglobin levels. Heart failure and COPD may increase the hemoglobin level due to the need by the body for more oxygen-carrying capacity. Dehydration may increase the hemoglobin level by hemoconcentration. Test-Taking Strategy: Use the process of elimination. Evaluate each condition in the options in terms of whether it is likely to raise or lower the hemoglobin level. This will direct you to option 4. Review the normal hemoglobin level and the causes of a low level if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection

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Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 491. 18. An adult male client admitted with dehydration has received fluid volume replacement. The nurse determines that the client has had adequate fluid resuscitation if the clients repeat hematocrit level has decreased to which of the following values in the normal range? 1. 56% 2. 48% 3. 39% 4. 34% Answer: 2 Rationale: The normal hematocrit level for an adult male is 42% to 52%. The client who is dehydrated has an elevated level because of hemoconcentration. The clients level may be expected to drift back down to within the normal range once fluid volume has been adequately restored. Thus, option 2 is the only correct choice. Option 1 is too high and options 3 and 4 are low. Test-Taking Strategy: Use the process of elimination and note the key words, normal range. Recalling the normal hematocrit level for an adult male will direct you to option 2. Review this normal value if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, pp. 487-489. 19. A client with diabetes mellitus has a glycosylated hemoglobin A (HbA1c) level of 8%. Based on this test result, the nurse plans to reinforce teaching measures with the client about the need to: 1. Avoid infection. 2. Take in adequate fluids. 3. Prevent hyperglycemia. 4. Prevent hypoglycemia. Answer: 3 Rationale: The glycosylated hemoglobin value measures the amount of glucose that has become permanently bound to the red blood cells from circulating glucose. Elevations in blood glucose levels will cause elevations in the amount of glycosylation. Thus, the test is useful in detecting clients who have periods of hyperglycemia that are undetected in other ways. Values are expressed as a percentage of total hemoglobin and include the following: diabetic with good control of 7.5% or lower; diabetic with fair control of 7.6% to 8.9%; diabetic with poor control of 9% or higher. Elevations indicate continued need for teaching related to prevention of hyperglycemic episodes. Test-Taking Strategy: Use the process of elimination and focus on the level identified in the question. Recalling the expected values related to this test and their significance will assist in answering correctly. Review this test if you had difficulty with this question.

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Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 472. 20. A client has been diagnosed as having syndrome of inappropriate antidiuretic hormone (SIADH) secretion following cranial surgery. The nurse interprets that this complication is not resolving if which of the following urine specific gravity measurements is obtained? 1. 1.002 2. 1.016 3. 1.020 4. 1.030 Answer: 4 Rationale: The normal range for urine specific gravity is from 1.016 to 1.022. Elevations may occur with SIADH, because the kidneys are stimulated to reabsorb water, thus causing unusual concentration of the urine. Option 1 represents a low value, which may be seen in the client with diabetes insipidus. Options 2 and 3 reflect normal values. Test-Taking Strategy: Use the process of elimination and note the key words, not resolving. Recalling the normal values for this test will assist in eliminating options 2 and 3. From the remaining options, recalling the pathophysiology associated with SIADH will direct you to option 4. Review this test if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 1013. 21. A nurse is caring for a client with a diagnosis of cancer who is immunosuppressed. The nurse knows that neutropenic precautions will be implemented if the clients white blood cell (WBC) count is: 1. 2000/L 2. 5800/L 3. 8400/L 4. 11,500/L Answer: 1 Rationale: The normal WBC count ranges from 4500 to 11,000/L. The client who is immunosuppressed has a decrease in the number of circulating WBCs. The nurse implements neutropenic precautions when the clients values fall sufficiently below the low-normal level. Test-Taking Strategy: Knowledge regarding the normal WBC count and the purpose of neutropenic precautions will direct you to option 1. Remember the normal WBC count ranges from 4500 to 11,000/L. Review this laboratory test if you had difficulty with this question. Level of Cognitive Ability: Comprehension

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Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 400. 22. A nurse volunteering at the health screening clinic teaches a 22-year-old client that diet and exercise should be used as tools to keep the total cholesterol level under: 1. 130 mg/dL 2. 200 mg/dL 3. 250 mg/dL 4. 300 mg/dL Answer: 2 Rationale: The normal cholesterol level is 140 to 199 mg/dL. The client should be counseled to keep the total cholesterol level under 200 mg/dL. This will aid in prevention of atherosclerosis, which can lead to a number of cardiovascular disorders later in life. Test-Taking Strategy: Use the process of elimination. Recalling the normal cholesterol level will direct you to option 2. Remember that the normal cholesterol level is 140 to 199 mg/dL. Review this normal level if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 369. 23. A client has been admitted for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen (BUN) level drops to: 1. 35 mg/dL 2. 29 mg/dL 3. 15 mg/dL 4. 6 mg/dL Answer: 3 Rationale: The normal BUN value for the adult is 8 to 25 mg/dL. Thus, option 3 is correct. Values such as those in options 1 and 2 reflect continued dehydration. Option 4 reflects a lower than normal value, which may occur with fluid overload, among other conditions. Test-Taking Strategy: Use the process of elimination and note the key words, adequate volume replacement. Recalling the normal BUN level will direct you to option 3. Remember that the normal BUN for the adult is 8 to 25 mg/dL. Review this level if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th

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ed.). Philadelphia: W.B. Saunders, p. 1111. 24. A nurse is reviewing the laboratory results of a female adult client suspected of having iron deficiency anemia. The nurse reviews the results knowing that the normal hemoglobin level for this client is: 1. 10 g/dL 2. 14 g/dL 3. 17 g/dL 4. 19 g/dL Answer: 2 Rationale: The normal hemoglobin level for an adult female is 12 to 15 g/dL. Option 1 is a low value and would indicate an anemia. Options 3 and 4 are elevated values. Test-Taking Strategy: Knowledge regarding the normal hemoglobin level will direct you to option 2. Remember that the normal hemoglobin level for an adult female is 12 to 15 g/dL. If you are unfamiliar with this laboratory value, review its normal value. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Pagana, K., & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 490. 25. A nurse is assigned to a 40-year-old client admitted with chronic pancreatitis. The nurse reviews the clients record and expects to note a serum amylase level that is most similar to which of the following values? 1. 25 U/L 2. 100 U/L 3. 300 U/L 4. 500 U/L Answer: 3 Rationale: The normal serum amylase level is 25 to 151 U/L. In chronic cases of pancreatitis, the rise in serum amylase levels usually does not exceed three times the normal value. In acute pancreatitis, the value may exceed five times the normal value. Therefore, option 3 is correct. Test-Taking Strategy: Note the key word, chronic. Recalling that the normal serum amylase level is 25 to 151 U/L and understanding the effects of chronic pancreatitis on this laboratory value will direct you to option 3. Review these effects if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 172. <AQ>26. Several laboratory tests are prescribed for a client and the nurse reviews the results of the tests. Select the laboratory tests that are abnormal. ___White blood cells, 3,000/L

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___Neutrophils, 1000/L ___Thyroid-stimulating hormone (thyrotropin; TSH), 0.4 U/mL ___Phosphorus, 9.6 mg/dL ___Magnesium, 1.0 mg/dL ___Calcium, 7.0 mg/dL ___Blood urea nitrogen, 10 mg/dL ___Serum creatinine, 1.0 mg/dL Answers: White blood cells, 3,000/L Neutrophils, 1000/L Magnesium, 1.0 mg/dL Calcium, 7.0 mg/dL Rationale: The normal values include the following: white blood cells, 4500 to 11,000/L; neutrophils, 56% or 1800 to 7800/L; thyroid-stimulating hormone, 0.2 to 5.4 U/mL; phosphorus, 2.7 to 4.5 mg/dL; magnesium, 1.6 to 2.6 mg/dL; calcium, 8.6 to 10.0 mg/dL; blood urea nitrogen, 5 to 20 mg/dL; and serum creatinine, 0.6 to 1.3 mg/dL. Test-Taking Strategy: Note the key word abnormal in the question. Knowledge of the normal laboratory values for these studies will assist in answering this question. Review these normal values if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Fundamental Skills Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, pp. 700, 1034, 1163, 1263-1264.

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