NCLEX- Electrolytes and lab Test

The nurse who is caring for a client with kidney failure notes that the client is dyspneic, and crackles are heard when listening to breath sounds in the lungs. Which additional sign/symptom would the nurse expect to note in this client?

ANS: An increase in blood pressure

The nurse is providing directions to a client about how to test a stool for occult blood. The nurse cautions that which could cause a false-negative result?

ANS: Ascorbic acid

A child is receiving edetate calcium disodium (calcium EDTA) for the treatment of lead poisoning. Which laboratory result would be important to monitor during treatment?

ANS: Blood urea nitrogen (BUN) level

The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse would tell the client that which food item is least likely to contain calcium?

ANS: Butter

The nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL (3.25 mmol/L). Which prescribed medication would the nurse plan to assist in administering to the client?

ANS: Calcitonin

Which laboratory result would verify the diagnosis of bacterial meningitis?

ANS: Cloudy cerebrospinal fluid with high protein and low glucose levels

The nurse caring for a male client with a diagnosis of gastrointestinal (GI) bleeding reviews the client's laboratory results and notes a hematocrit level of 30%. Which action would the nurse take?

ANS: Report the abnormally low level.

The nurse is assisting in monitoring a client who may be started on parenteral nutrition (PN). The nurse reviews the client's laboratory results and determines that the client is at risk of severe malnutrition if the report indicates which critical level?

ANS: Serum albumin 2.8 g/dL

Etidronate, an antihypercalcemic medication, is prescribed for a client. Which information would the nurse reinforce when instructing the client about taking this medication?

ANS: Take 2 hours before meals.

The nurse is reviewing the health care records of assigned clients. Which clients are at highest risk for excess fluid volume? Select all that apply.

ANS: The client with renal failure The client with chronic congestive heart failure (CHF)

A client has been admitted to the hospital with a diagnosis of severe nausea and vomiting. The client has an indwelling intravenous (IV) catheter. The client's morning laboratory results show a serum blood sodium level of 130 mEq/L (130 mmol/L) and a serum blood chloride level of 92 mEq/L (92 mmol/L). Which IV fluids would provide free water, sodium, and chloride to the client? Select all that apply.

ANS: 0.45% sodium chloride in water solution Dextrose 5% in 0.225% sodium chloride solution

The nurse is obtaining the report for a group of assigned clients. The nurse plans to monitor the serum potassium levels in which clients at risk for hyperkalemia? Select all that apply.

ANS: A client with a new burn injury A client diagnosed with acute kidney injury (AKI)

A client is admitted to the hospital with a diagnosis of malnutrition. The nurse is told that blood will be drawn to determine whether the client has a protein deficiency. Which laboratory data indicate that the client is experiencing a protein deficiency? Select all that apply.

ANS: Albumin, 2.2 g/dL Transferrin, 90 mg/dL Prealbumin, 10 mg/dL

The nurse is caring for a client with cirrhosis who is experiencing fluid overload. The nurse would determine that this problem is resolving if which data are obtained? Select all that apply.

ANS: Decreasing body weight Decreasing abdominal girth

A client has a nasogastric tube in place that is attached to suction. The client is at risk for developing which electrolyte imbalances with prolonged suction? Select all that apply.

ANS: Hypokalemia Hyponatremia Hypomagnesemia

A client enters the emergency department confused, twitching, and having seizures. Upon assessment, flushed skin, dry mucous membranes, an elevated temperature, and poor skin turgor are noted. The serum sodium level is 172 mEq/L (172 mmol/L). Which interventions would the primary health care provider (PHCP) likely prescribe? Select all that apply.

ANS: Monitor vital signs. Monitor intake and output. Increase water intake orally. Monitor electrolyte levels Provide a sodium-reduced diet.

The nurse reviews an assigned client's laboratory report and notes a serum potassium level of 5.5 mEq/L (5.5 mmol/L). The nurse would determine that this is an expected finding if the client had which health problems? Select all that apply.

ANS: Severe burn injury Untreated ketoacidosis

The nurse is assisting in the care of a client who has a serum sodium level of 128 mEq/L (128 mmol/L). The nurse relates which of the client's signs and symptoms to this electrolyte imbalance? Select all that apply.

ANS: Weakness in all extremities Confusion with garbled speech Diarrhea with abdominal cramping

The nursing instructor asks the student to describe isotonic dehydration. The student correctly responds by stating which pathophysiological processes are occurring? Select all that apply.

ANS: "Water and electrolytes are lost in approximately the same proportion as they exist in the body." "A client who has a large blood loss due to an accident will initially have an isotonic dehydration."

The nurse reviews the client's laboratory results. Which abnormal findings would the nurse report? Select all that apply.

ANS: 1. Calcium 8.2 mg/dL 2. Potassium 6 mEq/L 3. Magnesium 2.9 mg/dL 4. Phosphorus 5.2 mg/dL

The metabolic panel of a client reveals a calcium level of 6.5 mg/dL (1.6 mmol/L). Based on this laboratory finding, which additional data specific to this calcium level would the nurse collect? Select all that apply.

ANS: 1. Presence of Chvostek's sign 2. Presence of electrocardiogram abnormalities 3. Presence of tingling in the fingertips and around the mouth 4. Presence of carpal spasm when blood pressure cuff is inflated above systolic blood pressure for a few minutes

A CD4+ count has been prescribed for a child with human immunodeficiency virus (HIV) infection. The mother asks the nurse about the purpose of the test and why the test needs to be done if it is already known that the child has HIV. The nurse would reinforce which information to the mother? Select all that apply.

ANS: 1. The CD4+ count is used to determine the child's immune status. 2. The CD4+ count is used to identify the risk for disease progression. 3. The CD4+ count identifies the need for Pneumocystis jiroveci pneumonia prophylaxis after 1 year of age. 4. The CD4+ count is measured at ages 1 and 3 months, every 3 months until the age of 2 years, and at least every 6 months thereafter. 5. More frequent monitoring of CD4+ counts is indicated when pneumonia prophylaxis and antiretroviral therapy are administered.

A primary health care provider (PHCP) has written a prescription for calcium carbonate for the client with hypocalcemia. The nurse is reinforcing teaching with the client and would include which instructions? Select all that apply.

ANS: 1.Take the calcium carbonate with or just after meals. 2.Avoid foods such as beets, spinach, and bran in the diet. 3.Take the medication with a full glass of water (8 oz/240 mL)

The nurse is caring for a group of clients on a clinical nursing unit. The nurse checks for signs of deficient fluid volume. Which clients are at risk for this fluid imbalance? Select all that apply.

ANS: A client with pneumonia A client with an ileostomy A client with a temperature of 102.5° F (39.2° C)

Which of these clients are most likely to develop fluid (circulatory) overload? Select all that apply.

ANS: A premature infant A 101-year-old man A client with heart failure A client receiving renal dialysis

A client has a prescription to take sodium polystyrene sulfonate for several days. The client also needs to make some dietary changes. Which foods would the client avoid? Select all that apply.

ANS: Cabbage Mushrooms Strawberries

Several laboratory tests are prescribed for a client, and the nurse reviews the results of the tests. Which laboratory results warrant a call to the primary health care provider (PHCP)? Select all that apply.

ANS: Calcium, 7 mg/dL Magnesium, 1 mg/dL White blood cells (WBC), 3000 mm3

A primary health care provider is caring for a client who is human immunodeficiency virus (HIV) positive and has delivered a newborn baby. The nurse anticipates which interventions would be employed for the newborn to decrease the risk of HIV? Select all that apply.

ANS: HIV testing of the newborn within 48 hours Antiretroviral prophylaxis for newborns testing HIV positive Periodic testing for HIV at set intervals until the age of 6 months

The nurse is reviewing the complete blood count (CBC) laboratory results of a female adult client suspected of having iron deficiency anemia. The nurse reviews the results and determines that which results are consistent with this diagnosis? Select all that apply.

ANS: Hematocrit (Hct) 30% Hemoglobin (Hgb) 8.8 g/dL Decreased mean corpuscular volume (MCV) 66 fL

The nurse is caring for a client whose magnesium level is 3 mEq/L (1.5 mmol/L) and the client is being treated for the magnesium imbalance. The nurse interprets that the electrolyte imbalance is resolving if which signs or symptoms are no longer present? Select all that apply.

ANS: Hypotension Loss of deep tendon reflexes

A 0.9% intravenous (IV) solution is prescribed for a client. The IV is to run at 100 mL/hr. The nurse prepares the solution, understanding that which are characteristics of this type of solution? Select all that apply.

ANS: Is the same solution as sodium chloride 0.9% Is used to administer red blood cell transfusion Is used to treat hypotension due to fluid volume deficit

The nurse is reviewing the laboratory results of a client hospitalized with a diagnosis of Crohn's disease. The client has a magnesium level of 1.0 mEq/L (0.5 mmol/L). Which nursing interventions would the nurse initiate? Select all that apply.

ANS: Monitor the client for dysrhythmias. Notify the primary health care provider (PHCP) of the laboratory results.

A hospitalized client with heart disease who is taking digoxin has a digoxin level prescribed. The level is elevated above normal. Based on this finding the nurse plans to notify the registered nurse and primary health care provider (PHCP) and anticipates which additional interventions will be prescribed? Select all that apply.

ANS: Monitor the potassium level. Place the client on cardiac monitor. Monitor the blood urea nitrogen (BUN) and creatinine.

A client is at risk for developing hypocalcemia. The nurse determines which signs are associated with this electrolyte disturbance? Select all that apply.

ANS: Positive Trousseau's sign Fine tremors noted in hands

The nurse is reading a client's urinalysis report. The nurse interprets which item found on the report to be considered abnormal? Select all that apply.

ANS: Positive protein Leukocyte esterase positive White blood cells, 10 per high power screen

The nurse is reviewing the laboratory results from the lumbar puncture performed on a client with a diagnosis of meningitis. Which findings are indicative of a bacterial infection? Select all that apply.

ANS: Protein level of 20 mg/dL Increased white blood cells A cerebrospinal fluid (CSF) pressure of 250 mm H2O

A nurse is about to give a daily dose of digoxin and notes that a serum digoxin level drawn earlier in the day measured 2.7 ng/mL. The nurse would take which actions? Select all that apply.

ANS: Report the finding to the registered nurse. Gather data from the client related to signs of toxicity.

A client has a serum sodium level of 129 mEq/L (129 mmol/L) because of hypervolemia. The nurse anticipates the primary health care provider to prescribe which measures? Select all that apply.

ANS: Restrict fluid intake. Monitor electrolytes every 24 hours.

The nurse is told in a report that the client has hypocalcemia. Which signs would the nurse expect to note during the data collection? Select all that apply.

ANS: Tetany A positive Chvostek sign A positive Trousseau sign

The nurse is caring for a group of clients on a clinical nursing unit. The nurse interprets that which assigned clients are at risk for excess fluid volume? Select all that apply.

ANS: The client with renal failure The client with chronic cirrhosis

A client is suspected of having a myocardial infarction. The nurse would expect elevations in which laboratory values to support the diagnosis? Select all that apply.

ANS: Troponin I Creatinine phosphokinase MB (CPK-MB)

The nurse is planning to reinforce dietary teaching about following a diet that is low in potassium to a client receiving a potassium-retaining (sparing) diuretic. The nurse would be sure to include which strategies to avoid foods high in potassium in the diet? Select all that apply.

ANS: Use eggs as a source for protein. Avoid eating lunch meats and bolognas. Eat salads with cabbage and lettuce and avoid spinach.

The nurse is caring for a client with a nasogastric tube in place for gastric decompression. The gastroenterologist prescribes to have the tube irrigated once every 8 hours. Select the correct interventions the nurse would utilize in performing this procedure. Select all that apply.

ANS: Utilize 30 mL of 0.9% normal saline for the irrigating solution. After injecting the irrigating solution, pull back on the irrigation syringe.

A client is admitted to the hospital with a fever and extreme weakness. Which laboratory studies are likely to be elevated if the client is experiencing an infection? Select all that apply.

ANS: White blood cell count (WBC) Erythrocyte sedimentation rate (ESR)

Which laboratory results indicate a therapeutic drug level? Refer to chart. Select all that apply.

ANS: tegretol garamycin theophylline

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 urine specific gravity measurement is obtained?

ANS: 1.030

A client with a history of seizure disorder is having a routine serum phenytoin level drawn. The nurse who receives a telephone report of the results notes that the client's blood level of the medication is within the normal range if which value is reported?

ANS: 15 mcg/mL

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 which value?

ANS: 15 mg/dL

A client has been treated for dehydration and pneumonia. The nurse evaluates that the client has been successfully treated if the blood urea nitrogen (BUN) level is which value?

ANS: 19 mg/dL

The nurse volunteering at the health screening clinic reinforces instructions to a 22-year-old client that diet and exercise would be used as tools to keep the total cholesterol level under at least which level?

ANS: 200 mg/dL

The nurse is calculating a client's 24-hour fluid intake. The client consumed coffee (8 oz), water (8 oz), and orange juice (6 oz) for breakfast; soup (4 oz) and iced tea (8 oz) for lunch; and milk (10 oz), tea (8 oz), and water (8 oz) for dinner. The client also consumed 24 oz of water during the day. How many milliliters of fluid did the client consume in the 24-hour period? Fill in the blank.

ANS: 2520- The client consumed a total of 84 oz of fluid. Because 1 oz is equal to 30 mL, multiply 84 oz by 30 mL/oz. This yields 2520 mL.

The nurse is assigned to a hospitalized client with chronic pancreatitis. The nurse reviews the client's record and expects to note a serum amylase level that is most likely which value?

ANS: 300 units/L

The nurse is monitoring the laboratory results of a client preparing to receive chemotherapy. The nurse determines that the white blood cell count (WBC) is normal if which result is present?

ANS: 5000 mm3 (5 × 109/L)

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 distress, a sample for a theophylline level is drawn. The nurse notes the therapeutic range for the serum theophylline level is 10 to 20 mcg/mL and determines that the client may not be taking the medication as prescribed if which result is obtained?

ANS: 6 mcg/mL

The nurse is caring for a group of clients. Which client is most likely to have a serum phosphorus level of 2.0 mg/dL (0.64 mmol/L)?

ANS: A client with a history of alcoholism

The nurse is assisting in caring for a client with severe hyponatremia resulting from hypervolemia. The nurse anticipates which treatment would be prescribed by the primary health care provider?

ANS: Administer hypertonic normal saline solution intravenously.

The nurse is caring for a client recovering from hepatitis. The nurse recognizes the need to report which laboratory test result to the primary health care provider?

ANS: Alanine aminotransferase (ALT) that is significantly elevated

The nurse is reviewing the results of a client's serum laboratory studies. Which result indicates a deficiency of protein intake?

ANS: Albumin, 2.6 mg/dL

The nurse working the 3:00 to 11:00 pm shift notes that a client with coronary artery disease (CAD) has a prescription for serum lipid levels to be drawn in the morning. The nurse places the client on which dietary preparation to ensure accurate test results?

ANS: Fasting for 12 hours

The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom would be an indication of this electrolyte imbalance?

ANS: Generalized muscle weakness

The nurse is reviewing the laboratory results of a client scheduled for surgery. Which laboratory result would indicate to the nurse that the surgery might be postponed?

ANS: Hemoglobin, 8.4 g/dL

The nurse admits a client with a diagnosis of dehydration and a positive history of cancer to the nursing unit. The client is extremely weak and has an irregular heart pulse rhythm. There are absent bowel sounds, and the client's last bowel movement was 4 days earlier. The nurse plans to review serum electrolyte levels because the client is at high risk for which electrolyte imbalance?

ANS: Hypercalcemia

The nurse is assigned to care for a group of clients on the clinical nursing unit. Which client is least likely to develop third spacing of fluids?

ANS: Hypertension

Which cardiovascular sign would the nurse expect to note in a client with a diagnosis of hypocalcemia?

ANS: Hypotension

A client is admitted to the hospital with a diagnosis of suspected myocardial infarction (MI). The nurse is reviewing the laboratory results performed on the client. Which documented laboratory result specifically indicates the presence of an MI?

ANS: Increased creatine kinase (CK-MB)

The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding would the nurse expect to note as a result of this long-term use?

ANS: Increased specific gravity of the urine

The nurse is caring for a client with a diagnosis of hyperparathyroidism. Laboratory studies are performed, and the serum calcium level is 12.0 mg/dL (3.0 mmol/L). Based on this laboratory value, the nurse would take which action?

ANS: Inform the registered nurse of the laboratory value.

The nurse is caring for a client with kidney failure. The laboratory results reveal a magnesium level of 3.6 mEq/L (1.8 mmol/L). Which sign would the nurse expect to note in the client, based on this magnesium level?

ANS: Loss of deep tendon reflexes

The nurse is monitoring the fluid balance of a client with advanced human immunodeficiency virus (HIV) infection. Because the client has lost a great deal of weight and muscle mass, the nurse understands that which action will provide a reliable indicator of fluid balance?

ANS: Monitoring for decreased urine output and hypotension

The nurse is assisting in caring for a client who is receiving an intravenous infusion of 1000 mL of normal saline with 40 mEq of potassium chloride. The nurse is monitoring the client for signs of hyperkalemia. Which sign/symptom would be noted in the client if hyperkalemia is present?

ANS: Muscle weakness

The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4 mEq/L. What would the nurse look for on the cardiac monitor as a result of this laboratory value?

ANS: Narrow, peaked T waves

A licensed practical nurse (LPN) is assisting in the care of a client receiving a continuous intravenous (IV) infusion of heparin sodium for deep vein thrombosis (DVT). The LPN notes that the result of a newly drawn activated partial thromboplastin time (aPTT) level is 90 seconds. The client's baseline before the initiation of therapy was 30 seconds. The LPN would take which action?

ANS: Notify the RN about the value immediately.

A client presents in the emergency department reporting severe nausea, vomiting, and diarrhea for 5 days. The client is weak, has 2+ tenting skin turgor, and states a weight loss of 7 pounds in the last week. At this time, which action would the nurse take?

ANS: Obtain orthostatic vital signs.

A client with a history of seizure disorder is receiving phenytoin in the hospital. The client has a seizure and the nurse reviews the laboratory results of the phenytoin level of 18 mcg/mL. The therapeutic level is 10 to 20 mcg/mL. The nurse understands from reviewing the medication level that which is the correct situation?

ANS: Phenytoin alone is not effectively controlling seizures.

A client is receiving standard oral anticoagulant therapy with warfarin. The result of a newly drawn international normalized ratio is 3.8 seconds. The client needs to have an invasive procedure done on the next day. Which medication will likely be ordered to reverse the anticoagulant effect?

ANS: Phytonadione

The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. Which additional sign/symptom would the nurse expect to note in this client if hyponatremia is present?

ANS: Postural blood pressure changes

The nurse is monitoring a client who is attached to a cardiac monitor and notes the presence of U waves. The nurse checks the client and then reviews the results of the client's recent electrolyte results. The nurse expects to note which electrolyte value?

ANS: Potassium 3.0 mEq/L

An adult client has had serum electrolytes drawn. The nurse receiving the results by telephone from the laboratory would be most concerned with which result?

ANS: Potassium 5.4 mEq/L

A client with diabetes mellitus has a glycosylated hemoglobin A (HbA1c) level of 8%. Which instruction does the nurse plan to reinforce to the client based on this test result?

ANS: Prevent hyperglycemia.

The nurse reviews the client's serum calcium level and notes that the level is 8.0 mg/dL (2.0 mmol/L). The nurse understands that which condition would cause this serum calcium level?

ANS: Prolonged bed rest

The nurse is reading a computer printout of the results of a cerebrospinal fluid (CSF) analysis performed on an adult client who underwent lumbar puncture. The nurse knows that a reported value of 0 is normal for which substance in CSF?

ANS: Red blood cells

A client with diabetes mellitus calls the clinic nurse to report that the blood glucose level is 150 mg/dL. After obtaining further data from the client, the nurse determines that the client ate lunch approximately 2 hours ago. How would the nurse interpret the data?

ANS: The blood glucose level is slightly higher than the normal value

The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for a potassium deficit?

ANS: The client receiving nasogastric suction

The nurse is reading the primary health care provider's (PHCP's) progress notes in the client's record and sees that the PHCP has documented "insensible fluid loss of approximately 800 mL daily." Which client is at risk for this loss?

ANS: The client with a fast respiratory rate

The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for fluid volume deficit?

ANS: The client with an ileostomy

The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at the least likely risk for the development of third-spacing?

ANS: The client with diabetes mellitus

The nurse reviews electrolyte values and notes a sodium level of 130 mEq/L (130 mmol/L). The nurse expects that this sodium level would be noted in a client with which condition?

ANS: The client with the syndrome of inappropriate secretion of antidiuretic hormone

The nurse checks a client's skin turgor and documents that the client exhibits normal fluid balance. Which statement correctly describes what the nurse has documented?

ANS: The skin when pinched immediately fell back to normal when released.

The nurse is explaining to a client the reason a peak and trough has been prescribed because the client is receiving an antibiotic. Which reason for the blood levels would be included in the teaching plan?

ANS: To determine if the dose of the antibiotic is effective against the organism causing the infection

The nurse reviews a client's electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands that a potassium value at this level would be noted with which condition?

ANS: Traumatic burn

A client is seen in the urgent care center for complaints of chest pain 2 days ago. Since that time, the client has not been feeling well and fatigues easily. The nurse reviews the results of the laboratory tests. An elevation of which laboratory test indicates a myocardial infarction occurred at the time of chest pain 2 days ago?

ANS: Troponin I

Which electrocardiogram changes would the nurse note on the cardiac monitor with a client whose potassium (K+) level is 2.7 mEq/L (2.7 mmol/L)?

ANS: U waves

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?

ANS: Uric acid level of 8.4 mg/dL

A client undergoing renal dialysis is prescribed calcitriol to treat hypocalcemia. The nurse reinforces instructions and informs the client that this medication is also known as which nutrient?

ANS: Vitamin D

The nurse is reviewing laboratory results and notes that the client's international normalized ratio (INR) is 2.2. The nurse would realize this test is performed to monitor the effectiveness of which medication?

ANS: Warfarin