Lab values - NCLEX RN

A nurse cares for a group of clients with acid-base imbalances. Which client does the nurse assess first? A client with emphysema, respiratory acidosis, and an SpO2 of 89% on room air A client with diabetic ketoacidosis, metabolic acidosis, and a potassium level of 3.2 mEq/L A client with prolonged vomiting and metabolic alkalosis who reports tingling in the fingers A client with renal failure and metabolic acidosis who is scheduled for hemodialysis in an hour

A client with prolonged vomiting and metabolic alkalosis who reports tingling in the fingers

A client with end stage kidney disease (ESKD) is discharging home. Which statement indicates the client understands the education from the nurse? "I must quit taking my sertraline immediately." "I will avoid magnesium hydroxide antacids." "I will avoid eating foods high in vitamin C." "I should not take the bumetanide any longer."

"I will avoid magnesium hydroxide antacids."

A nurse assesses a client with hyperaldosteronism and subsequent acid-base imbalance. Which client statement does the nurse expect? "My heartbeat feels slow and weak." "I have swelling in my feet." "My mouth and toes feel tingly." "I can't seem to catch my breath."

"My mouth and toes feel tingly."

A nurse on the cardiac step-down unit prepares discharge teaching for the client with heart failure (HF). Which information does the nurse include in the teaching? "Report any weight gain of two pounds or more in 24 hours." "Maintain a calcium intake of less than 400 milligrams in 24 hours." "Maintain a sodium intake of less than four grams daily." "Increase fluid intake to prevent dehydration."

"Report any weight gain of two pounds or more in 24 hours."

A client with chronic kidney disease (CKD) has a magnesium level of 3.5 mg/dL. The nurse administers which medication to help normalize the client's magnesium level? 0.9 normal saline at 200 mL/hr IV 2 g magnesium citrate IV 60 g sodium polystyrene PO four times daily 100 mg spironolactone PO every morning

0.9 normal saline at 200 mL/hr IV --- Administration of fluids, both oral and IV, promote excretion of magnesium for client's functioning kidneys. A client who has not only CKD but also end stage renal disease may require dialysis to remove excess magnesium.

The client with scheduled heart-valve surgery in eight hours takes warfarin at home. The client's international normalized ratio (INR) is 2.3. Knowing that the healthcare provider (HCP) wants the INR to be less than 2.0 prior to surgery, the nurse prepares to administer which treatment to the client? 5 mg oral warfarin 50 mg IV protamine sulfate 2 units packed RBCs 10 mg IV vitamin K

10 mg IV vitamin K

The nurse evaluates medical prescriptives for appropriateness. The nurse administers IV 0.45% saline solution to which client? An alert client with a closed head injury A client with hyperosmolar hyperglycemia A client with heart failure exacerbation A client with acute multiple trauma and bleeding

A client with hyperosmolar hyperglycemia

The nurse cares for a group of clients with acid-base imbalances. Which client does the nurse assess closely for risk of respiratory acidosis? A postoperative client with decreased respirations A pediatric client with a two-day history of vomiting An older adult client with stage 3 chronic kidney disease A young adult client with diabetic ketoacidosis

A postoperative client with decreased respirations

A client with chronic kidney disease has a potassium level of 6.0 mEq/L. The nurse is aware that this condition may be treated in which ways? (SATA) Encourage increasing intake of fruits and vegetables. Administer sodium polystyrene 60 g rectally. Administer IV dextrose 50% and regular insulin. Infuse lactated Ringer's at 150 mL/hr intravenously. Prepare bumetanide 4 mg to give intravenously.

Administer sodium polystyrene 60 g rectally. Administer IV dextrose 50% and regular insulin. Prepare bumetanide 4 mg to give intravenously.

A client with an enteral feeding tube develops hyponatremia. The nurse takes which action? Administer insulin. Administer water. Administer sodium. Administer glucose.

Administer sodium.

The client has a sodium level of 125 mEq/L. Which nursing assessment supports the healthcare provider's diagnosis of hyponatremia related to fluid overload? BP 80/40 mm Hg Bilateral 3+ ankle edema Lightheadedness Weak, thready radial pulse

Bilateral 3+ ankle edema--- Peripheral edema, a full or bounding pulse, and normal-to-hypertensive BP may be seen in fluid volume overload.

The nurse cares for a client with prolonged and intractable vomiting. Which clinical finding does the nurse determine is a complication of this condition? PaCO2 58 mm Hg Sodium 148 mEq/L Blood pH 7.48 Calcium 9.1 mg/dL

Blood pH 7.48

The nurse administers 2,000 mL of a hypotonic fluid instead of the 2% hypertonic NaCl ordered to a client with hyponatremia. The nurse knows that administration of too much hypotonic fluid can result in which problem for the client? Cellular edema Cellular dehydration Fluid volume overload Hypertension

Cellular edema

A client receives parenteral nutrition and develops hypomagnesemia. The nurse monitors for which complication? Circumoral paresthesia Arrhythmia Polyuria Respiratory arrest

Circumoral paresthesia --- Tingling or numbness around the mouth is a sign of hypomagnesemia. A client with hypomagnesemia may also experience paresthesia in their fingers, mental changes, and hyperreflexia. Increase magnesium supplements in the client.

The nurse instructs the client with heart failure (HF) to notify the healthcare provider (HCP) of which symptoms? (SATA) Cold lasting three days or more Rings or shoes not fitting Increased urination during the day Dyspnea during exercise Sleeping in the reclining chair

Cold lasting three days or more Rings or shoes not fitting Sleeping in the reclining chair

A client receiving continuous enteral feeding has a sodium level of 132 mEq/L. The nurse takes which action first? Determine the total volume of water intake in the past 24 hours. Put the feeding on hold and notify the healthcare provider. Administer 200 mL of 0.9% saline solution via the feeding tube. Take no action because this result is not clinically significant.

Determine the total volume of water intake in the past 24 hours. --- When receiving enteral feedings, a common cause of sodium imbalance is excessive water volumes being administered. Given the low sodium result, the nurse should try to determine the total amount of water being administered to help guide treatment decisions.

A client with type 1 diabetes mellitus reports dysuria and a home blood sugar result of 564 mg/dL. While waiting for the prescriptions of the healthcare provider (HCP), which assessments does the nurse perform on the client? (SATA) Determine mental status. Evaluate respirations. Check for edema. Check BP. Check pulse oximetry.

Determine mental status. Evaluate respirations. Check BP.

A client receiving continuous enteral feeding has a sodium level of 132 mEq/L. The nurse takes which action first? Determine the total volume of water intake in the past 24 hours. Put the feeding on hold and notify the healthcare provider. Administer 200 mL of 0.9% saline solution via the feeding tube. Take no action because this result is not clinically significant.

Determine the total volume of water intake in the past 24 hours.

A nurse cares for an endurance runner who has sodium bicarbonate infusion for treatment of metabolic acidosis secondary to rhabdomyolysis. During the nurse's assessment of the client, the nurse notes the client is lethargic, confused, and breathing rapidly. What is the nurse's priority when caring for the client? (Place each option in order, from first priority to last.) Complete a full body assessment on the client. Change the client's plan of care to address mental status. Ensure the sodium bicarbonate is infusing correctly. Notify the health care provider of the client's status.

Ensure the sodium bicarbonate is infusing correctly. Notify the health care provider of the client's status. Complete a full body assessment on the client. Change the client's plan of care to address mental status.

A nurse cares for an endurance runner who has sodium bicarbonate infusion for treatment of metabolic acidosis secondary to rhabdomyolysis. During the nurse's assessment of the client, the nurse notes the client is lethargic, confused, and breathing rapidly. What is the nurse's priority when caring for the client? (Place each option in order, from first priority to last.) Complete a full body assessment on the client. Ensure the sodium bicarbonate is infusing correctly. Notify the health care provider of the client's status. Change the client's plan of care to address mental status.

Ensure the sodium bicarbonate is infusing correctly. Notify the health care provider of the client's status. Complete a full body assessment on the client. Change the client's plan of care to address mental status.

A client who works construction has a temperature of 104.5° F (40.3° C), a BP of 84/40 mm Hg, dry skin, and reports shivering, confusion, and decreased urination. The nurse provides which interventions for this client? (SATA) Give the client 1 mg lorazepam IV. Administer 650 mg acetaminophen rectally. Administer 1 g salt tablet by mouth. Start bolus of 0.9 NaCl IV. Encourage the client to drink 500 mL of water.

Give the client 1 mg lorazepam IV. Start bolus of 0.9 NaCl IV.

A client with diabetes and a blood glucose level of 53 mg/dL reports feeling shaky, weak, and lightheaded. The nurse performs which intervention for the client? Give the client 4 ounces of orange juice to drink. Instruct the client to drink 16 ounces of water. Administer 50 mL of dextrose 50% intravenously . Hold the client's next dose of insulin due.

Give the client 4 ounces of orange juice to drink.

A client reports a "blow to the head" during football practice two days ago and subsequent increased thirst and urination. The nurse assesses closely for which other symptom? Tea-colored urine Pitting edema 2+ Heart rate 110 beats/min Bounding pulses

Heart rate 110 beats/min

The nurse admits a client with severe dehydration. Which laboratory result does the nurse evaluate to support the client's admitting diagnosis of severe dehydration? Hemoglobin 15.8 g/dL Sodium 143 mEq/L Potassium 4.8 mEq/L Hematocrit 55%

Hematocrit 55% ---Hematocrit (the percentage of blood volume made of RBCs) typically increases with dehydration due to less fluid volume. Hematocrit of 55% is above the normal range of 37-52%.

The nurse cares for a client with metabolic alkalosis. Which condition does the nurse recognize as the possible cause of the client's acid-base imbalance? Chronic kidney disease Hyperaldosteronism Chronic obstructive pulmonary disease Hyperventilation

Hyperaldosteronism

A nurse cares for a client with an acute intoxication of methylenedioxymethamphetamine (MDMA). Which laboratory finding is associated with MDMA intoxication? K+ 6.2 mEq/L HCO3 32 mEq/L Na+ 136 mEq/L pH 7.48

K+ 6.2 mEq/L

A client arrives at the emergency department's trauma unit by ambulance after a motor vehicle crash. The nurse recognizes which symptoms of shock in this client? (SATA) Urine output of 90 mL in 1 hour Mean arterial pressure of 58 mm Hg Heart rate of 115 beats/min Respiratory rate of 16 breaths/min Client pulling at lines and tubes

Mean arterial pressure of 58 mm Hg Heart rate of 115 beats/min Client pulling at lines and tubes

The nurse cares for a client with sepsis who has an elevated serum lactate level. Which acid-base imbalance does the nurse expect? Respiratory alkalosis Metabolic alkalosis Metabolic acidosis Respiratory acidosis

Metabolic acidosis ---- Elevated serum lactate results from anaerobic metabolism caused by inadequate perfusion and decreased oxygen delivery to the tissues. This elevation of lactate leads to lactic acidosis, a metabolic acidosis.

A client receiving parenteral nutrition (PN) has a serum magnesium level of 0.9 mEq/L. Which complication does the nurse expect to assess? Mouth tingling Polyuria Bradycardia Respiratory arrest

Mouth tingling --- A serum magnesium level of 0.9 mEq/L is low, so this client has hypomagnesemia. Symptoms of hypomagnesemia are similar to those of hypocalcemia (e.g., tingling around the mouth, tetany, and tremors).

The nurse reviews the ABG values for a client with bilateral pulmonary effusions. Which finding requires further intervention from the nurse? PaCO2 40 mm Hg PaCO2 55 mm Hg PaO2 80 mm Hg pH 7.36

PaCO2 55 mm Hg

A nurse assesses a client and finds the client somnolent and weak with a respiratory rate of 8 breaths/min. Which acid-base finding does the nurse anticipate when analyzing the client's ABG results? pH 7.41 PaCO2 56 mm Hg HCO3 18 mm Hg PaO2 98 mm Hg

PaCO2 56 mm Hg

The nurse reviews the ABG findings of a client: pH 7.51, PaCO2 49 mm Hg, PaO2 85 mm Hg, and HCO3 35 mEq/L. How does the nurse interpret these results? Uncompensated metabolic acidosis Partially compensated respiratory acidosis Uncompensated metabolic alkalosis Partially compensated metabolic alkalosis

Partially compensated metabolic alkalosis ---The results represent a partially compensated metabolic alkalosis. Alkalosis is present (pH >7.45) with elevated HCO3 (normal range is 21-28 mEq/L), making it a metabolic alkalosis. It is partially compensated because the PaCO2 is elevated; the lungs are trying to retain carbon dioxide to decrease alkalosis.

A client with a history of myocardial infarction (MI) reports shortness of breath, fatigue, and weight gain of 10 pounds in the last three days. The nurse immediately notifies the healthcare provider (HCP) of which assessment finding? Respiratory rate 24 breaths/min Heart rate 115 beats/min Pitting edema 3+ Pink, frothy sputum

Pink, frothy sputum

Following a total hip replacement, a client has a hematocrit of 23.1%, a BP of 82/44 mm Hg, and a heart rate of 116 beats/min. After notifying the health care provider (HCP) of these findings and ensuring adequate oxygenation, which action does the nurse take to help this client? Elevate the client's head to 90 degrees. Place 18-gauge IV in the antecubital vein. Discontinue IV lactated Ringer's. Remove dressing to check for bleeding.

Place 18-gauge IV in the antecubital vein. --- The nurse places a second large-bore IV in anticipation of additional fluid or blood product administration.

A nurse cares for a pediatric client with an acid-base imbalance due to an accidental overdose of antacids. The nurse prepares for which intervention? Placement of endotracheal tube for ventilation Administering high-flow oxygen via non-rebreather mask IV infusion of sodium bicarbonate Placement of nasogastric tube for gastric suction

Placement of nasogastric tube for gastric suction

A client who was burned three days ago has diuresed 3,000 mL over the past 24 hours and has decreasing edema. The nurse notifies the healthcare provider (HCP) of which lab result during the fluid mobilization phase? Sodium 133 mg/dL Potassium 3.2 mEq/L Hematocrit 29% Hemoglobin 8.8 g/dL

Potassium 3.2 mEq/L --- The client with a burn in the fluid mobilization phase is at risk for hypokalemia due to excretion of potassium in the urine and reabsorption of potassium by the cells. A potassium level of 3.2 mEq/L is below the normal range (3.5-4.5 mEq/L) and requires potassium replacement.

The client admitted to the ICU with multiple crush injuries shows a heart rate of 58 beats/min, small P waves, broad QRS waves, and tall T waves on the EKG. The nurse suspects which laboratory result for the client? Potassium 6.8 mEq/L Calcium 5.0 mg/dL Magnesium 1.2 mg/dL Sodium 118 mEq/L

Potassium 6.8 mEq/L

A client with liver failure related to cirrhosis has increasing abdominal girth and an albumin level of 2.9 g/dL. After notifying the healthcare provider (HCP), which action is most appropriate for the nurse to take for the client? Encourage the client to remain supine in bed. Hold the client's dose of furosemide 40 mg oral. Provide the client with a protein shake supplement. Administer 20 grams of lactulose orally.

Provide the client with a protein shake supplement.

A nurse cares for a malnourished client receiving parenteral nutrition (PN). The nurse monitors for what complications? (SATA) Nausea Pulmonary edema Constipation Fever Neurological changes

Pulmonary edema fever neurological changes

The nurse cares for a client with severe pain and a respiratory rate of 32 breaths/min. Which acid-base imbalance does the nurse expect to find with sustained tachypnea? Respiratory acidosis Metabolic acidosis Metabolic alkalosis Respiratory alkalosis

Respiratory alkalosis -- A prolonged respiratory rate may lead to respiratory alkalosis (blood pH >7.35, PaCO2 <35 mm Hg). This occurs because the client "blows off" PaCO2, creating the acid-base imbalance.

The client who underwent a two-vessel coronary artery bypass graft five days ago has a serum creatinine level of 1.9 mg/dL, a BUN level of 32 mg/dL, and a 24-hour urine output of 630 mL. Which is the first action the nurse performs? Ask the client if there is a past history of kidney problems. Review preoperative serum creatinine and BUN levels. Continue to monitor the client's urine output closely. Notify the healthcare provider of the lab results.

Review preoperative serum creatinine and BUN levels.

The nurse reviews the client's WBC differential. The nurse knows that which laboratory results indicate the client may have a severe bacterial infection? (SATA) Segmented neutrophil 68% Basophil 0% Eosinophil 0% Lymphocyte 20% Monocyte 12%

Segmented neutrophil 68% Monocyte 12%

A client with dehydration reports syncope and has a blood pressure of 82/48 mmHg. The nurse places the client in which position? Supine with the pillows elevating the client's feet. Fowler with the pillows under the knees. Prone with the pillows under the head Reverse Trendelenburg with pillows under arms

Supine with the pillows elevating the client's feet.

An infant client is admitted for fever and diarrhea. Which finding best indicates that the client is dehydrated? The client's crying stops when sucking on a cold washcloth. The client's extremities feel cool to the touch bilaterally. The client's heart rate is slightly increased when sleeping. The client's most recent wet diaper was four hours ago.

The client's heart rate is slightly increased when sleeping.

The client presents to the emergency department reporting substernal chest pain. The nurse knows that which laboratory level supports the healthcare provider's diagnosis of acute myocardial infarction for the client? Creatine kinase-MB 0% Troponin-I 1.24 ng/mL Creatine kinase 50 U/L Myoglobin 50 mcg/L

Troponin-I 1.24 ng/mL

A client's ABG results reveal a serum pH of 7.49, a PaCO2 of 41 mm Hg, and an HCO3 level of 38 mEq/L. How does the nurse interpret these results? Uncompensated metabolic acidosis Compensated respiratory acidosis Compensated metabolic alkalosis Uncompensated metabolic alkalosis

Uncompensated metabolic alkalosis---- There is an increase in pH (alkalosis) and HCO3 (metabolic in origin), but the PaCO2 is still normal, which shows the lungs are not yet compensating by retaining PaCO2 via hypoventilation.

The client with chronic kidney disease (CKD) on hemodialysis has a potassium level of 6.2 mEq/L. The nurse knows the client is at risk for which complication? Ventricular fibrillation Paralytic ileus General paresthesia Auditory hallucinations

Ventricular fibrillation

Two days after a repair for an abdominal aortic aneurysm, a client requires 1 unit of packed red blood cells (PRBCs) for hemoglobin of 7.6 g/dL and hematocrit of 23.1%. After receiving the PRBCs from the blood bank, which action does the nurse perform first at the client's bedside? Get the client's signed consent for blood. Obtain a baseline set of vital signs. Start a 20-gauge IV access. Verify the blood with a second nurse.

Verify the blood with a second nurse.

A client with type 2 diabetes presents to the emergency department with Kussmaul respirations and fruity breath. The nurse suspects what ABG result for the client? pH 7.50 PaO2 70 mm Hg pCO2 27 mm Hg HCO3 30 mEq/L

pCO2 27 mm Hg

A client with type 2 diabetes presents to the emergency department with Kussmaul respirations and fruity breath. The nurse suspects what ABG result for the client? pH 7.50 PaO2 70 mm Hg pCO2 27 mm Hg HCO3 30 mEq/L

pCO2 27 mm Hg The nurse suspects the client's pCO2 level to be below the normal range of 35-45 mm Hg with Kussmaul respirations, as the lungs try to compensate for the metabolic acidosis.

A client who overdosed on heroin is unresponsive and has a respiratory rate of 8 breaths/min. Which ABG result does the nurse anticipate? pH 7.49, PaCO2 45 mm Hg, HCO3 33 mEq/L pH 7.28, PaCO2 60 mm Hg, HCO3 26 mEq/L pH 7.31, PaCO2 41 mm Hg, HCO3 18 mEq/L pH 7.38, PCO2 45 mm Hg, HCO3 26 mEq/L

pH 7.28, PaCO2 60 mm Hg, HCO3 26 mEq/L

A nurse cares for a client with type 1 diabetes and a serum blood glucose of 400 mg/dL. Which set of ABGs does the nurse expect to find? pH 7.45, PaCO2 38 mm Hg, HCO3 23 mEq/L pH 7.29, PaCO2 22 mm Hg, HCO3 14 mEq/L pH 7.31, PaCO2 67 mm Hg, HCO3 32 mEq/L pH 7.39, PaCO2 43 mm Hg, HCO3 22 mEq/L

pH 7.29, PaCO2 22 mm Hg, HCO3 14 mEq/L

The nurse cares for a client with an acid-base imbalance who has required prolonged gastric suctioning. Which ABG results does the nurse expect? pH 7.31, PaCO2 60 mm Hg, HCO3 29 mEq/L pH 7.49, PaCO2 30 mm Hg, HCO3 22 mEq/L pH 7.28, PaCO2 40 mm Hg, HCO3 16 mEq/L pH 7.48, PaCO2 45 mm Hg, HCO3 38 mEq/L

pH 7.48, PaCO2 45 mm Hg, HCO3 38 mEq/L

The nurse cares for a client with an adrenocorticotropic hormone (ACTH)-secreting pituitary tumor with hypercortisolism. Upon assessment, the client has profound muscle weakness. Which ABG result does the nurse expect? pH 7.48, PaCO2 22 mm Hg, HCO3 26 mEq/L, SaO2 93% pH 7.24, PaCO2 55 mm Hg, HCO3 28 mEq/L, SaO2 98% pH 7.49, PaCO2 35 mm Hg, HCO3 40 mEq/L, SaO2 94% pH 7.24, PaCO2 38 mm Hg, HCO3 18 mEq/L, SaO2 93%

pH 7.49, PaCO2 35 mm Hg, HCO3 40 mEq/L, SaO2 94% --- This ABG result represents metabolic alkalosis (high pH, normal PaCO2, high HCO3), which is consistent in a client with an ACTH-secreting pituitary tumor with subsequent hypercortisolism.