NCLEX Lab Values & ?'s
blood base excess
+/- 2 mEq/L
4.3-10.8 × 103/mm3
...
Purpose of ADH
...
Cr infant
.4 - 1.2
digoxin
.5-2
Creatinine
.7-1.4
Lipase
0 - 150 units/L
Prostate-Specific Antigen (PSA)
0 - 4 ng/mL (likely higher with age)
Urine WBC
0 -4
AST
0 to 35 liver and cardiac
direct bilirubin
0-0.2 mg/dl
Trust vs. Mistrust
0-18 mo.
ESR
0-20 mm/hr
CSF WBC
0-5/mm3
CPK-MB
0-6% (0-7 units/L)
bands
0-8%
Total bilirubin
0.0-1.5 mg/dL
Troponin T value that is consistent with a Myocardial Infarction.
0.1 to 0.2 ng/mL
Bilirubin Direct
0.1- 0.3 mg/dL
bilirubin total
0.1-1
indirect bilirubin
0.1-1 mg/dl
acetaminophen (Tylenol)
0.2-0.6 (>5 is toxic)
bilirubin total
0.2-1.3 mg/dl
TSH
0.2-5.5 milliunits/L
Bilirubin Total
0.3- 1.0 mg/dL
basophils
0.4-1%
Lithium (therapeutic/toxic)
0.4-1.0 mEq/L greater than 2.0 mEq/L is toxic
Creatinine
0.5 - 1.5 mg/dL
Thyroid-Stimulating Hormone (TSH)
0.5 - 6.0 µ units/ml
normal serum cr female
0.5 to 1 mg/dL
lithium
0.5 to 1.2
DIG level
0.5 to 2
Therapeutic Digoxin Range
0.5 to 2 ng/mL
Mag
0.5 to 2.6 fruits nuts peas soy
lithium (Eskalith)
0.5-1.5
creatinine
0.5-1.5 mg/dl
Digoxin
0.5-2 ng/ml
digoxin (Lanoxin)
0.5-2.0
Digoxin Levels
0.5-2.0 mg/mL
Digoxin Level (Therapeutic)
0.5-2.0 ng/mL (held for apical pulse <60, >120)
Creatinine
0.6 - 1.2 mg/dL
CREAT
0.6 to 1.3
Serum Creatinine
0.6 to 1.3 mg/dL
Creatinine
0.6-1.2 normal elevated = A
Lithium level
0.6-1.2 over 1.5 is toxic
normal serum cr male
0.6-1.3 mg/dL
Creatinine
0.6-1.35 mg/dL
Serum Creatinine
0.6-1.35 mg/dL (<2 in older adults)
Creatinine
0.7-1.4
T4 Free
0.7-2 ng/dl
INR
0.8-1.1 CRITICAL VALUE=.5.5 (> THE VALUE THE LONGER IT TAKES TO CLOT)
Lithium Levels
0.8-1.5 mEq/L
Digoxin (therapeutic/toxic)
0.8-2.0 ng/mL greater than 2.4 ng/mL is toxic
CSF RBC
0/mm3
INR
1
Erythrocyte Sedimentation Rate (ESR or Sed-Rate) Male
1 - 13 mm/hr
Erythrocyte Sedimentation Rate (ESR or Sed-Rate) female
1 - 20 mm/hr
lithium
1-1.5
bilirubin (newborn)
1-10 mg/dl
eosinophils
1-4%
INR
1.0 2-3: therapy for a fib, DVT, and pulm embolism 2.5-3.5: therapy for prosthetic heart valves
Lithium Level (Therapeutic)
1.0-1.5 mEq/L
Specific Gravity
1.001-1.030 urinalysis
Urine specific gravity range
1.005 - 1.030
Normal Urine Specific Gravity
1.005 - 1.030 (normally 1.010-1.025) ↓ with elderly adults
Urine Specific Gravity
1.010 - 1.030
Urine specific gravity
1.010 - 1.030
urine specific gravity
1.010-1.025
Specific Gravity
1.010-1.030
Urine specific gravity
1.010-1.030
urine specific gravity
1.010-1.030
Urine Specific Gravity
1.010-1.030
Urine specific gravity normal
1.015 - 1.024
Normal urine specific gravity level
1.016 to 1.022
Magnesium
1.2 - 2.1 mEq/L
INR
1.3 - 2.0 therapeutic level 2-3 can be up to 4.5
PT, anticoagulation therapy, in sec
1.5 - 2 times the control
Magnesium
1.5 - 2.0 mEq/L
creatinine clearance
1.5 - 2.5
Magnesium, mEq
1.5 - 2.5 mEq/L
aPTT, anticoagulant therapy, in sec
1.5 - 2.5 times the control
Globulin
1.5 - 3.5 g/dL
Therapeutic PT level
1.5 to 2 times the normal value.
magnesium
1.5-2.5 mEq/L
Magnesium
1.5-2.5 mg/dL
Normal magnesium levels
1.5-3.0 mEq/L
lidocaine (Xylocaine)
1.5-6.0
Bleeding Time
1.5-9.5
Bleeding Time
1.5-9.5 minutes (dur. of bleeding after a standardized incision)
Magnesium
1.6 to 2.6 mg/dL
Phosphorus, mEq
1.7 - 2.6 mEq/L
Magnesium, mg
1.8 - 3.0 mg/dL
Convert Celsius to Fahrenheit
1.8 X C + 32 = F
magnesium
1.8-3 mg/dL
Magnesium
1.8-3 mg/dL serum electrolyte
PT - Prothrombin Time
10 - 13 sec
BUN
10 - 20 mg/dL
Lipase
10 to 140 rises after 24 hrs
serum lipase levels
10 to 140 units/L
dilatin
10 to 20
theo
10 to 20
Serum Ammonia level
10 to 80 mcg/dL
With fewer than ____ cells/L circulating granulocytes, the risk of infection increases significantly.
10,000
urine culture: colony count of _______ bacterial units/mL of urine is not significant
10,000
PT (monitor if on coumadin)
10-13 sec
phenytoin
10-20
phenytoin (Dilantin)
10-20
theophylline
10-20
theophylline (Theo-Dur)
10-20
Dilantin
10-20 mcg/dL
Dilantin Level (Therapeutic)
10-20 mcg/dL
Theophylline
10-20 mcg/dL
Theophylline Level (Therapeutic)
10-20 mcg/dL
Aminophylline (therapeutic/toxic)
10-20 mcg/mL greater than 20 mcg/mL is toxic
Theophylline (therapeutic/toxic)
10-20 mcg/mL greater than 20 mcg/mL is toxic
Phenytoin (therapeutic/toxic)
10-20 mcg/mL greater than 30 mcg/mL is toxic
Dilantin
10-20 meq/ml
BUN
10-20 mg/dL renal function
Phenobarbital (therapeutic/toxic)
10-30 mcg/mL greater than 40 mcg/mL is toxic
ALT (SGPT)
10-60 units/L
Ammonia
10-80 mcg/d/L
Transferrin: when less than ____ mg/dL the level of protein depletion is severe.
100
urine culture: colony count of _______ bacterial units/mL of urine is positive culture
100,000
A positive urine culture for cystitis would be accompanied by what 3 symptoms?
100,000; dysuria, frequency, and urgency
In order for a urine culture to be positive for pyelonephritis what number of bacterial unit/mL and be accompanied by what 2 symptoms?
100,000; fever and flank pain
LDH Cholesterol
100-190 U/L
triglycerides
100-200
salicylate (Aspirin)
100-200 (>200 is toxic)
Triglycerides
100-200mg/dL (detects risk for atherosclerosis)
Salicylate (therapeutic/toxic)
100-250 mcg/mL greater than 300 mcg/mL is toxic
Normal BUN to Creatinine
10:1 to 15:1
BUN/Cr ratio
10:1 to 20:1
PT
11-14 sec
PT
11-14 seconds Therapeutic range for anti coagulation therapy is 1.5-2 X the normal or control value
PT
11.0 -12.5 seconds CRITICAL VALUE > 20 seconds. desired range for anticoag therapy= >1.5-2 x's control value (20-30%) (> THE VALUE THE LONGER IT TAKES TO CLOT)
Prothrombin time (PT)
11.0-12.5 sec
HGB - hemoglobin, female
12 - 15 g/dL
Hemoglobin Female
12 - 16 gm/dL
Normal female hemoglobin
12 to 15 g/dL
hemoglobin (F)
12-14 g/100ml
Hgb
12-18
Hgb
12-18 8-11 = B under 8 = C, call MD transfusion likely
GTT 3 hours
125
Hemoglobin Male
13 - 18 gm/dL
hemoglobin (M)
13-16 g/100 ml
HGB - hemoglobin, male
13.5 - 17 g/dL
Cholesterol
130-200 mg/dL
Total cholesterol
130-200 mg/dL
Sodium (Na+)
134-144 mEq/L
Na+
135 - 145
Sodium
135 - 145 mEq/L
Sodium
135 to 145 processed foods ketshup bacon white or whole wheat bread
Na
135-145 abnomal = B If change in LOC = C
Normal sodium levels
135-145 mEq/L
sodium
135-145 mEq/L
Sodium
135-145 mEq/L serum electrolyte
HGB
14 to 16 slightly less for women
prealbumin
14-40 mg/dl
GTT 2 hours
140
CHO
140 to 199
cholesterol
140-200 mg/dl
Ammonia
15 - 50 µg
ammonia
15-45
CSF protein
15-45 mg/dl
ammonia
15-56 mcg/dl (keep < 75)
Platelet Count
150,000 - 350,000/mL
Platelets
150,000 - 400,000
Platelet count
150,000 - 400,000 per microliter
normal platelet count range
150,000 to 400,000
Normal platelet count
150,000 to 400,000 cells/mm3
platelets (thrombocytes)
150,000-400,000
platelets
150,000-400,000 under 90,000 = C under 40,000 = D
Platelet Count
150,000-450,000
Platelets
150,000-450,000 cu/mm
Normal 24 Hour output of urine
1500 cc
platelet
150000 - 400000
PTT-partial thromboplastin time
16-40 range anything over 100 is BAD remain less than 40 seconds. Therapeutic range for anti coagulation therapy is 1.5-2.5 X the normal or control value
Autonomy vs. Shame and Doubt
18 mo. - 3 yrs.
Normal fibrinogen level men
180 to 340 mg/dL
Neutrophils
1800 to 7800 mm3
GTT 1 hour
190
Normal fibrinogen level female
190 to 420 mg/dL
INR (International Normalization Ratio)
2 - 3 for anticoagulant therapy
Normal CVP
2 - 6 mmHg 5 - 10cm H₂O
Aspirin (therapeutic level)
2-20 mg/dl
INR (if taking coumadin)
2-3
gastric aspirate pH
2-3 nmol/h
INR
2-3 therapeutic over 4 = C, hold coumadin, assess for bleeding, prepare vitamin K, call MD
INR Coumadin
2-3.5
quinidine (Quinalgute)
2-6
monocytes
2-8%
Uric Acid female
2.0 to 7.0 mg/dL (likely higher with age)
INR
2.0-3.0
Therapeutic INR
2.0-3.0
therapeutic INR
2.0-3.0
Ionized Calcium, mEq
2.2 - 2.5 mEq/L
ADH
2.3 - 3.1 pg/ml
Globulin
2.3 - 3.5 gm/dL
Free T3
2.3 to 4.2
Phosphorus, mg
2.5 - 4.5 mg/dL
INR (if prosthetic heart valves)
2.5-3.5
Phosphorus
2.5-4.5 mg/dL
phosphorus
2.5-4.5 mg/dL
Phosphorus
2.5-4.5 mg/dL serum electrolyte
phosphorous
2.5-4.5 mg/dl
Serum Albumin
2.5-5.5
Phos
2.7 to 4.5 fish organ meats fish whole grain cereals
Phosphorus
2.7 to 4.5 mg/dL
phorphorus
2.7 to 4.5 mg/dL
Uric Acid, female
2.8 - 6.8 mg/dL
aPTT - activated Partial Thromboplastin Time
20 - 35 sec
Partial Thromboplastin Time (PTT)
20 - 40 sec
Normal aPTT
20 and 36 seconds
urine culture: colony count of _______ bacterial units/mL of urine is inconclusive
20,000 to 50,000
PTT
20-40
Transferrin
200 - 430 mg/dL
Total cholesterol level should be under..
200 mg/dL
Platelets
200,000-400,000
Total Cholesterol moderate risk
200-240
CPK (creatinine phosphokinase=heart, brain or muscle tissue)
21-232 U/L
transferrin
215-375 mg/dl
Bicarbonate (HCO3)
22 to 26 mEq/liter
Hco3
22 to 27 dizziness tremors dysrthythmias anorexia hypoventilation
HCo3
22-26
HCO3
22-26 abnormal = A
Bicarb
22-26 mEq/L
HCO3
22-26 mEq/L
HCO3-bicarbonate
22-26 mEq/L ABG
venous CO2
22-30 mEq/L
aPTT (monitor if on heparin)
22-32 sec
TIBC
229-365 mcg/dl
HCO3
24-26 mEq/L
Amylase
25 to 151 rises after 6 hrs after onset of pancreatic pain
Normal serum amylase level
25 to 151 units/L
amylase
25-130 units/L
lymphocytes
25-35%
Iron binding capacity (TIBC)
250 - 450 micrograms/dL
CK
26 to 174 elevates for 6 hours peaks at 18 and declines after 2 to 3 days
osmolarity
275-295 mOsm/kg
Osmolality
280 - 300 mOsm/kg
vitamin B12
280-1500 pg/ml
Osmolality (Blood)
285-295 mOsm/kg CRITICAL is < 265 or > 320
Central Venous Pressure (CVP)
3-12 cm/H2O 2-6 mm/Hg
folic acid
3-13 ng/ml
Phosphorus
3.0 - 4.5 mg/dL
Albumin
3.4 to 5
Ammonia
3.4 to 5 changes in loc
Albumin level
3.4 to 5 g/dL
Albumin
3.4-5.0 g/dL
Albumin
3.5 - 5 g/dL
Albumin
3.5 - 5 g/dL 35 - 50 g/L
K+
3.5 - 5.0
Albumin
3.5 - 5.0 gm/dL
Potassium
3.5 - 5.0 mEq/L
Potassium
3.5 - 5.3 mEq/L
Uric Acid, male
3.5 - 8.0 mg/dL
K
3.5 to 5 avocados banans fish potatos strawberry
K level
3.5 to 5.1 mEq/L
albumin
3.5-5 g/dl
potassium
3.5-5 mEq/L
Potassium
3.5-5 mEq/L serum electrolyte
potassium
3.5-5.0 mEq/L
Potassium (K+)
3.5-5.2 mEq/L
Potassium
3.5-5.3 low = C, assess the heart, prepare to give K+, call MD 5.4-5.9 = C, hold potassium, assess heart, prepare kayexlate/D5W w/ insulin, call MD OVER 6 = D, call rapid response team
serum Albumin
3.5-5.5
Serum Albumin
3.5-5.5g/dL 3.0-5.0 in older adults (detect protein malnutrition)
Uric Acid
3.5-7.5 mg/dL
Uric acid
3.5-7.5 mg/dL
Albumin
3.8-5 g/dL Liver function Urinalysis = negative
For a therapeutic dose of heparin, the pts value should not be less than___ seconds or greater than ____ seconds.
30 seconds; 90 seconds
ESR level during mild inflammation
30 to 40 mm/hr
HDL
30 to 70 "happy lipid"
vancomycin (Vancocin)
30-40 (peak), 5-10 (trough)
LDH (cardiac enzyme)
300-600 units/L
BNP (ANP--cardiac enzyme)
34-42 pg/ml > 100 = CHF
Carbon Dioxide Pressure (PCO2)
35 - 45 mm Hg
Pco2
35 to 45 lethargy dysrhythmias nausea numbness hyperventilation
Triglycerides female
35-135 mg/dl
Hct
35-42
co2
35-45
CO2
35-45 in 50s = C, assess respiratory, do pursed lip breathing in 60s = D, assess respiratory, do pursed lip breathing, prepare to intubate, call respiratory, call MD (rapid response team)
CO2
35-45 mEq/L
PaCO2
35-45 mm Hg
PaCO2
35-45 mm Hg ABG
pCO2
35-45 mmHg
paCO2
35-45 mmHg
Ammonia
35-65 mcg/dL Liver function
hdl
35-85
HCT - hematocrit, female
36 - 46%
Hct
36-54 abnormal = B (probable dehyrdation)
hematocrit level female
37 to 47%
hematocrit (F)
37-47%
Creatine Kinase (CK or CPK) male
38 - 174 units/L
ALT
4 to 6 liver disease
WBC (leukocyte count and white Blood cell count
4,300 - 10,800 cells/µL/cu mm
WBC (leukocyte count and white Blood cell count
4,300 - 10,800 cells/µL/cu mm 4.3-10.8 × 103/mm3
WBC
4,800-10,800 mm3 CBC urinalysis = negative
Gentamicin
4-10 ug/mL
carbamezepine (Tegretol)
4-12
RBCs
4-6 million
RBCs
4-6 million abnormal = B
Glycosylated Hemoglobin A (HbA1c) (therapeutic)
4-6% teach to prevent hyperglycemia
procainamide (Pronestyl)
4-8
Cardiac output (CO)
4-8 L/min
Magnesium Sulfate (therapeutic/toxic)
4-8 mg/dL greater than 9 mg/dL is toxic
RBC - female
4.0 - 5.0 million/microliter x 10^12/L
Uric Acid Male
4.0 to 8.5 mg/dL (likely higher with age)
RBC
4.2 - 6.2
Red Blood Cell Count (RBC)
4.2 - 6.9 million/µL/cu mm
Ionized Calcium, mg
4.25 - 5.25 mg/dL
Calcium, mEq
4.5 - 5.5 mEq/L
Urine ph
4.5 - 8
Total Thyroxine T4
4.5 to 12.5
ALP
4.5 to 13 bile obs liver ds and bone grwoth
RBC
4.5-5.0 million
HgbA1C (glycoslated)
4.5-6.5%
RBC - male
4.6 - 6 million/microliter x 10^12/L
Normal Urine pH
4.6 - 8 (average = 6)
Hematocrit Female
40 - 48%
HCT - hematocrit, male
40 - 50%
hematocrit level male
40 to 50%
ESR level moderate inflammation
40 to 70 mm/hr
Triglycerides male
40-160 mg/dl
Triglyceride
40-50 mg/dL
hematocrit (M)
40-50%
Hematocrit Male
42 - 50%
HCT
42 to 52 slightly less for women
normal male hematocrit level
42% to 52%
CSF glucose
45-80 mg/dl
WBC
4500 - 10,000 per microliter
Normal White Blood cell count
4500 to 11,000
White blood cells
4500 to 11,000 mm3
BUN
5 - 25 mg/dL
EPO Erythropoietin
5 - 35 units/L
tegretol
5 to 12
Hemoglobin A1c
5% (7% in diabetic)
HbA1c
5% (up to 7% in clients with DM)
WBC
5,000-10,000
WBCs
5,000-10,000
white blood cell count (WBC)
5,000-10,000/mm^3
WBCs
5,000-11,000; ANC over 500; CD4 over 200 if any low = C CD4 used for progrssion of HIV- if under 500 (2nd stage), if under 200 (4th stage) put on neutropenic precautions
Carbamazepine (Tegretol) (therapeutic)
5-12 mcg/mL
Theophylline
5-20 ng/ml
AST (SGOT)
5-40 units/L
urine pH
5-8
Total Protein
5.3mg/dL
T4 Total
5.5-11.5 mcg/dl
Iron
50 - 150 micrograms/dL
depokene
50 to 100
valproic acid
50-100
valproic acid (Depakene)
50-100
ALP
50-150
zinc
50-150 mg/dl
ck (creatinine kinase)
50-250
neutrophils (segs)
50-70%
WBC
5000 - 10,000
WBC
5000 - 10000
Normal serum amylase level
53 to 123 Somogyi units d/L
Total protein
6 - 8 g/dL
For an adult, the normal range for total serum protein level in the adult client is
6 to 8 g/dL
serum protein level for adult
6 to 8 g/dL
total protein
6-8 g/dl
Total protein
6-8 gm/dL liver function
Proteins (Total)
6.0 - 8.4 gm/dL
Protein
6.2-8.1 g/dL
Total Protein
6.5 -8.3
GTT fasting
60 - 110
Iron
60 - 160 µg/dL (normally higher in males)
Minimum urine output over 24 hour time period?
600CC *It is OK for the intake to exceed the output by 500cc
IRON
65 to 175 in men and slightly lower range values for women
In the test results for glycosylated hemoglobin A1C, what percentage indicates good control?
7% or less
In the test results for glycosylated hemoglobin A1C, what percentage indicates fair control?
7% to 8%
BUN
7-18 mg/dl
BUN
7-20
BUN
7-22 mg/dL
Acidity (pH)
7.35 - 7.45
PH
7.35 to 7.45
pH range
7.35 to 7.45
blood pH
7.35-7.45
pH
7.35-7.45
pH
7.35-7.45 Elderly is 7.25-7.45 ABG Urinalysis 2.6-8
pH
7.35-7.45 pH in 6's = D, get a set of vitals, call MD, call rapid response team
Glucose - fasting
70 - 110 mg/dL
Glucose Tested after fasting
70 - 110 mg/dL
normal fasting blood glucose
70 to 110 mg/dL
ESR level severe inflammation
70 to 150 mm/hr
Glucose
70-110 mg/dL
Glucose
70-110 mg/dL fasting serum electrolyte Urinalysis = negative
fasting blood glucose
70-110 mg/dl
glucose (FBS)
70-110 mg/dl
PO2
78-100 70-77 = C, assess respiratory, give O2 low 60s = D, assess respiratory, give O2, prepare to intubate, call respiratory, call MD (rapid response team)
cortisol (adrenal function)
8 am = 5-23 mcg/dl 4 pm = 2.5-12 mcg/dl
Calcium
8 to 10 collard greens rhubarb sardines milk
BUN
8 to 25
BUN level
8 to 25 mg/dL
Normal BUN level
8 to 25 mg/dL
In the test results for glycosylated hemoglobin A1C, what percentage indicates poor control?
8% or higher
Urea Nitrogen (BUN)
8-20 mg/dL
BUN
8-30 elevated = B, check for dehyrdation
AST / ALT
8-40
AST (aspartate transaminase)
8-40 units (liver enzyme)
Ca
8.5 - 10.0
Calcium
8.5 - 10.5 mg/dL (normally slightly higher in children)
Blood Volume
8.5 - 9.1% of total body weight
Calcium
8.5-10 mg/dL
calcium
8.5-10 mg/dL
Calcium
8.5-10 mg/dL serum electrolyte (Thyroid)
calcium
8.5-10 mg/dl
Normal calcium levels
8.5-10.5 mg/dL
Calcium level
8.6 to 10 mg/dL
Calcium (Ca+)
8.7-10.2 mg/dL
Po2
80 to 100
PaO2
80%-100%
pao2
80-100
pO2
80-100 mg
PaO2
80-100 mm Hg ABG
T3 Total
80-200 ng/dl
chloride
85-115 mEq/L
Cl-chloride
85-115 mEq/L ABG
Calcium, mg
9 - 11 mg/dL
PT
9.5 - 12
pt
9.5 - 12
Female Adult P.T.
9.5 to 11.3 seconds
normal PT for an adult female
9.5 to 11.3 seconds
normal PT for male
9.6 to 11.8 seconds
Male Adult Normal P.T.
9.6 to11.8 seconds
GFR- glomerular filtration rate
90-120 mL/min Renal function
O2 Sat
93-100 under 93 = C, assess respiratory status, give O2
Chloride
95 - 105 mEq/L
Chloride
95-105 mEq/L
chloride
95-105 mEq/L
sa o2
95-98
Creatine Kinase (CK or CPK) female
96 - 140 units/L
Chloride
96-106 mEq/L
Chloride
98 - 106 mEq/L
chloride
98 to 107 aids in digestion
CRP
< 0.5 mg/dl
C-Peptide for Type I IDDM
< 1
INR (normal)
< 1
Hypomagnesium levels
< 1.5 mEq/L
LDL
< 100 mg/dl
urine c & s
< 100000
Hyponatremia levels
< 135 mEq/L
triglycerides
< 150 mg/dl (> 200 = high)
Cholesterol
< 200 mg/dL
CA 125 (cancer marker)
< 34 units/ml
PSA (cancer marker)
< 4 ng/ml
HA1c
< 7
HgbA1C (IDDM)
< 7%
Hypocalcium levels
< 8.5 mg/dL
Bilirubin
<1.0 mg/dL
LDH
<100
ldl
<140
Triglyceride
<150 mg/dL
Cholesterol
<160
Total Cholesterol
<160: no CAD and <2 risk factors <130: no CAD and 2+ risk factors <100 if CAD
Total Cholesterol (adult)
<200
ESR
<25
ESR Child
<35
PTT
<40 sec
BUN
<60yrs: 7-18 >60yrs: 8-20
ETOH (legally intoxicated)
> 0.08
ETOH (toxic level)
> 0.4 (can lead to death)
Hypernatremia levels
> 145mEq/L
Hypermagnesium levels
> 2.5 mEq/L (potent vasodilator)
C-Peptide for Type II NIDDM
> 4-5
HDL
> 45 mg/dl (near 60 is better)
Hypercalcium levels
> 5.3 mg/dL ionized serum calcium or > 10.5 mg/dL total serum calcium
SaO2
> 92%
Acetaminophen
>150 mcg/ml
Total Cholesterol high risk
>240
Urine WBC, indicates infection
>4
Lead Level (toxicity)
>9 mcg/dL
SaO2
>95%
B. Broccoli D. Nuts
A client admitted with squamous cell carcinoma of the lung has a serum calcium level of 14 mg/dl. The nurse should instruct the client to avoid which of the following foods upon discharge? Select all that apply. A. Eggs B. Broccoli C. Organ meats D. Nuts E. Canned salmon
B. Ensure the client is safe from falls and check the most recent potassium level
A client is admitted with diabetic ketoacidosis who, with treatment, has a normal blood glucose, pH, and serum osmolality. During assessment, the client complains of weakness in the legs. Which of the following is a priority nursing intervention? A. Request a physical therapy consult from the physician B. Ensure the client is safe from falls and check the most recent potassium level C. Allow uninterrupted rest periods throughout the day D. Encourage the client to increase intake of dairy products and green leafy vegetables.
A. Absent patellar reflex
A client is receiving an intravenous magnesium infusion to correct a serum level of 1.4 mEq/L. Which of the following assessments would alert the nurse to immediately stop the infusion? A. Absent patellar reflex B. Diarrhea C. Premature ventricular contractions D. Increase in blood pressure
D. Notify the physician of the urine output and hold the dose
A client is receiving intravenous potassium supplementation in addition to maintenance fluids. The urine output has been 120 ml every 8 hours for the past 16 hours and the next dose is due. Before administering the next potassium dose, which of the following is the priority nursing action? A. Encourage the client to increase fluid intake B. Administer the dose as ordered C. Draw a potassium level and administer the dose if the level is low or normal D. Notify the physician of the urine output and hold the dose
B. Excess fluid volume related to increased water retention
A client recently diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) complains of headache, weight gain, and nausea. Which of the following is an appropriate nursing diagnosis for this client? A. Deficient fluid volume related to decreased fluid intake B. Excess fluid volume related to increased water retention C. Deficient fluid volume related to excessive fluid loss D. Risk for injury related to fluid volume loss
B. 0.9 NS at an open rate
A client who had a recent surgery has been vomiting and becomes dizzy while standing up to go to the bathroom. After assisting the client back to bed, the nurse notes that the blood pressure is 55/30 and the pulse is 140. The nurse hangs which of the following IV fluids to correct this condition? A. D5.45 NS at 50 ml/hr B. 0.9 NS at an open rate C. D5W at 125 ml/hr D. 0.45 NS at open rate
C. "Poor nutrition has caused decreased blood protein levels, and fluid has moved from the blood vessels into the tissues."
A client who is admitted with malnutrition and anorexia secondary to chemotherapy is also exhibiting generalized edema. The client asks the nurse for an explanation for the edema. Which of the following is the most appropriate response by the nurse? A. "The fluid is an adverse reaction to chemotherapy." B. "A decrease in activity has allowed extra fluid to accumulate in the tissues." C. "Poor nutrition has caused decreased blood protein levels, and fluid has moved from the blood vessels into the tissues." D. "Chemotherapy has increased your blood pressure, and fluid was forced out into the tissues."
B. Notify the physician
A client who is post-gallbladder surgery has a nasogastric tube, decreased reflexes, pulse of 110 weak and irregular, and blood pressure of 80/50 and is weak, mildly confused, and has a serum of potassium of 3.0 mEq/L. Based on the assessment data, which of the following is the priority intervention? A. Withhold furosemide (Lasix) B. Notify the physician C. Administer the prescribed potassium supplement D. Instruct the client on foods high in potassium
D. Provide reassurance to the client and administer sedatives
A client who suffers from an anxiety disorder is very upset, has a respiratory rate of 32, and is complaining of lightheadedness and tingling in the fingers. ABG values are pH of 7.48, PaCO2 of 29, HCO3 of 24, and O2 is at 93% on room air. The nurse performs which of the following as a priority nursing intervention? A. Monitor intake and output B. Encourage client to increase activity C. Institute deep breathing exercises every hour D. Provide reassurance to the client and administer sedatives
D. Encourage the client to rest and to use pursed-lip breathing technique
A client with COPD feels short of breath after walking to the bathroom on 2 liters of oxygen nasal cannula. The morning's ABGs were pH of 7.36, PaCO2 of 62, HCO3 of 35 mEq/L, O2 at 88% on 2 liters. Which of the following should be the nurse's first intervention? A. Call the physician and report the change in client's condition B. Turn the client's O2 up to 4 liters nasal cannula C. Encourage the client to sit down and to take deep breaths D. Encourage the client to rest and to use pursed-lip breathing technique
C. Potassium and blood glucose levels
A client with a history of cardiac disease is taking a potassium-wasting diuretic (furosemide) and is seen in the emergency department for complaints of weakness. The nurse expects to evaluate which laboratory values? A. Albumin and protein levels B. Sodium and chloride levels C. Potassium and blood glucose levels D. Hemoglobin level and hematocrit
C. bowel movements.
A client with a potassium level of 5.5 mEq/L is to receive sodium polystyrene sulfonate (Kayexalate) orally. After administering the drug, the priority nursing action is to monitor A. urine output. B. blood pressure. C. bowel movements. C. ECG for tall, peaked T waves.\
C. Positive Chvostek's sign
A client with a recent thyroidectomy complains of numbness and tingling around the mouth. Which of the following findings indicates the serum calcium is low? A. Bone pain B. Depressed deep tendon reflexes C. Positive Chvostek's sign D. Nausea
C. Assess for signs of fluid overload
A client with a serum sodium of 115 mEq/L has been receiving 3% NS at 50 ml/hr for 16 hours. This morning the client feels tired and short of breath. Which of the following interventions is a priority? A. Turn down the infusion B. Check the latest sodium level C. Assess for signs of fluid overload D. Place a call to the physician
C. Metabolic alkalosis (
A client with a small bowel obstruction has had an NG tube connected to low intermittent suction for two days. The nurse should monitor for clinical manifestations of which acid-base disorder? A. Respiratory alkalosis B. Respiratory acidosis C. Metabolic alkalosis D. Metabolic acidosis
D. Milk of magnesia
A client with chronic renal failure receiving dialysis complains of frequent constipation. When performing discharge teaching, which over-the-counter products should the nurse instruct the client to avoid at home? A. Bisacodyl (Dulcolax) suppository B. Fiber supplements C. Docusate sodium D. Milk of magnesia
D. Check to see if a serum albumin level is available
A client with chronic renal failure reports a 10 pound weight loss over 3 months and has had difficulty taking calcium supplements. The total calcium is 6.9 mg/dl. Which of the following would be the first nursing action? A. Assess for depressed deep tendon reflexes B. Call the physician to report calcium level C. Place an intravenous catheter in anticipation of administering calcium gluconate D. Check to see if a serum albumin level is available
C. Call the physician D. Report the urine output E. Report indications of nausea
A client with heart failure is complaining of nausea. The client has received IV furosemide (Lasix), and the urine output has been 2500 ml over the past 12 hours. The client's home drugs include metoprolol (Lopressor), digoxin (Lanoxin), furosemide, and multivitamins. Which of the following are the appropriate nursing actions before administering the digoxin? Select all that apply. A. Administer an antiemetic prior to giving the digoxin B. Encourage the client to increase fluid intake C. Call the physician D. Report the urine output E. Report indications of nausea
B. Hypocalcemia
A client with hypoparathyroidism complains of numbness and tingling in his fingers and around the mouth. The nurse would assess for what electrolyte imbalance? A. Hyponatremia B. Hypocalcemia C. Hyperkalemia D. Hypermagnesemia
D. Magnesium
A client with pancreatitis has been receiving potassium supplementation for four days since being admitted with a serum potassium of 3.0 mEq/L. Today the potassium level is 3.1 mEq/L. Which of the following laboratory values should the nurse check before notifying the physician of the client's failure to respond to treatment? A. Sodium B. Phosphorus C. Calcium D. Magnesium
C. Place client in high-Fowler's position
A client with pneumonia presents with the following arterial blood gases: pH of 7.28, PaCO2 of 74, HCO3 of 28 mEq/L, and PO2 of 45, which of the following is the most appropriate nursing intervention? A. Administer a sedative B. Place client in left lateral position C. Place client in high-Fowler's position D. Assist the client to breathe into a paper bag
C. pH of 7.33, PCO2 of 35, HCO3 of 17
A client with renal failure enters the emergency room after skipping three dialysis treatments to visit family out of town. Which set of ABGs would indicate to the nurse that the client is in a state of metabolic acidosis? A. pH of 7.43, PCO2 of 36, HCO3 of 26 B. pH of 7.41, PCO2 of 49, HCO3 of 30 C. pH of 7.33, PCO2 of 35, HCO3 of 17 D. pH of 7.25, PCO2 of 56, HCO3 of 28
D. Decreased central venous pressure (CVP)
A nurse caring for a client who has been receiving intravenous diuretics suspects that the client is experiencing a deficient fluid volume. Which assessment finding would the nurse note in a client with this condition? A. Lung congestion B. Decreased hematocrit C. Increased blood pressure D. Decreased central venous pressure (CVP)
C. Prolonged QT interval
A nurse caring for a client with hypocalcemia would expect to note which of the following changes on the electrocardiogram? A. Widened T wave B. Prominent U wave C. Prolonged QT interval D. Shortened ST segment
C. Depressed ST segment
A nurse caring for a client with severe malnutrition reviews the laboratory results and notes a magnesium level of 1.0 mg/dL. Which electrocardiographic change would the nurse expect to note based on the magnesium level? A. Prominent U waves B. Prolonged PR interval C. Depressed ST segment D. Widened QRS complexes
D. The client who has sustained a traumatic burn
A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a potassium level of 5.5 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a potassium value at this level? A. The client with colitis B. The client with Cushing's syndrome C. The client who has been overusing laxatives D. The client who has sustained a traumatic burn
B. The client who is taking diuretics
A nurse caring for a group of clients reviews the electrolyte laboratory results and notes a sodium level of 130 mEq/L on one client's laboratory report. The nurse understands that which client is at highest risk for the development of a sodium value at this level? A. The client with renal failure B. The client who is taking diuretics C. The client with hyperaldosteronism D. The client who is taking corticosteroids
A. Apples
A nurse instructs a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines that the client understands the food sources of potassium if the client states that the food item lowest in potassium is: A. Apples B. Carrots C. Spinach D. Avocado
A. Twitching
A nurse is assessing a client with a suspected diagnosis of hypocalcemia. Which of the following clinical manifestations would the nurse expect to note in the client? A. Twitching B. Negative Trousseau's sign C. Hypoactive bowel sounds D. Hypoactive deep tendon reflexes
A. A client with a colostomy
A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for deficient fluid volume? A. A client with a colostomy B. A client with congestive heart failure C. A client with decreased kidney function D. A client receiving frequent wound irrigations
B. The client with renal failure
A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for excess fluid volume? A. The client taking diuretics B. The client with renal failure C. The client with an ileostomy D. The client who requires gastrointestinal suctioning
C. Sodium chloride
A nurse is caring for a client with a nasogastric tube. Nasogastric tube irrigations are prescribed to be performed once every shift. The client's serum electrolyte results indicate a potassium level of 4.5 mEq/L and a sodium level of 132 mEq/L. Based on these laboratory findings, the nurse selects which solution to use for the nasogastric tube irrigation? A. Tap water B. Sterile water C. Sodium chloride D. Distilled water
C. Hyperactive bowel sounds
A nurse is caring for a client with acute congestive heart failure who is receiving high doses of a diuretic. On assessment, the nurse notes that the client has flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. The nurse suspects hyponatremia. What additional signs would the nurse expect to note in this client if hyponatremia were present? A. Dry skin B. Decreased urinary output C. Hyperactive bowel sounds D. Increased specific gravity of the urine
B. Requires nasogastric suction.
A nurse is preparing to care for a client with a potassium deficit. The nurse reviews the client's record and determines that the client was at risk for developing the potassium deficit because the client: A. Has renal failure. B. Requires nasogastric suction. C. Has a history of Addison's disease. D. Is taking a potassium-sparing diuretic.
A. The skin
A nurse is reading a physician's progress notes in the client's record and reads that the physician has documented "insensible fluid loss of approximately 800 mL daily." The nurse understands that this type of fluid loss can occur through: A. The skin B. Urinary output C. Wound drainage D. The gastrointestinal tract
A. Prolonged bed rest
A nurse is reviewing a client's laboratory report and notes that the serum calcium level is 4.0 mg/dL. The nurse understands that which condition most likely caused this serum calcium level? A. Prolonged bed rest B. Renal insufficiency C. Hyperparathyroidism D. Excessive ingestion of vitamin D
D. Processed oat cereals
A nurse is reviewing laboratory results and notes that a client's serum sodium level is 150 mEq/L. The nurse reports the serum sodium level to the physician and the physician prescribes dietary instructions based on the sodium level. Which food item does the nurse instruct the client to avoid? A. Peas B. Cauliflower C. Low-fat yogurt D. Processed oat cereals
A. U waves
A nurse reviews a client's electrolyte laboratory report and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse note on the electrocardiogram as a result of the laboratory value? A. U waves B. Absent P waves C. Elevated T waves D. Elevated ST segment
A. Alcoholism
A nurse reviews a client's laboratory report and notes that the client's serum phosphorus level is 2.0 mg/dL. Which condition most likely caused this serum phosphorus level? A. Alcoholism B. Renal insufficiency C. Hypoparathyroidism D. Tumor lysis syndrome
D. Tall peaked T waves
A nurse reviews the electrolyte results of an assigned client and notes that the potassium level is 5.4 mEq/L. Which of the following would the nurse expect to note on the electrocardiogram as a result of the laboratory value? A. ST depression B. Inverted T wave C. Prominent U wave D. Tall peaked T waves
D. Preparing the medication for bolus administration
A nursing student needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium? A. Obtaining a controlled IV infusion pump B. Monitoring urine output during administration C. Diluting in appropriate amount of normal saline D. Preparing the medication for bolus administration
C. weak, irregular pulse and poor muscle tone
A patient is receiving a loop diuretic. The nurse should be alert to which of the following symptoms? A. restlessness and agitation B. paresthesias and irritability C. weak, irregular pulse and poor muscle tone D. increased blood pressure and muscle spasms
What is a shift to the right?
A right shift indicates increased number of mature neutrophils which is seen with pernicious anemia and after tissue breakdown.
Definitions
A: abnormal (do nothing) B: be concerned (assess) C: critical (do something) D: deadly (do something NOW)
-pril
ACE inhibiltor Tx hypertension prevents production of antiotension (narrows blood vessels) SE: hypotension, hacking cough, N/V, respiratory symptoms
Standard precautions
AIDS/HIV, Hep. B, Hep. C, rotavirus
A. Deep tendon reflexes decreasing from +2 to +1
Which of the following assessment findings would indicate to the nurse that a client's diabetic ketoacidosis is deteriorating? A. Deep tendon reflexes decreasing from +2 to +1 B. Bicarbonate rising from 20 mEq/L to 22 mEq/L C. Urine pH less than 6 D. Serum potassium decreasing from 6.0 mEq/L to 4.5 mEq/L
C. 42-year-old woman with systemic lupus erythematosus and renal failure
Which of the following patients would be at greatest risk for the potential development of hypermagnesemia? A. 83-year-old man with lung cancer and hypertension B. 65-year-old woman with hypertension taking -adrenergic blockers C. 42-year-old woman with systemic lupus erythematosus and renal failure D. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection
B. Baked chicken D. Baked potato
Which of the following should the nurse include in the diet teaching for a client with a sodium level of 158 mEq/L? A. Pretzels B. Baked chicken C. Chicken bouillon D. Baked potato E. Baked ham
D. Chloride is lost in hydrochloride acid
Which of the following should the nurse include when preparing to teach a class on the regulation and functions of electrolytes? A. Sodium is essential to maintain intracellular fluid water balance B. Magnesium is essential to the function of muscle, red blood cells, and nervous system C. Less calcium is excreted with aging D. Chloride is lost in hydrochloride acid
C. The lungs speed up to release carbon dioxide and increase the pH.
Which statement best explains the scientific rationale for Kussmaul's respirations in the client diagnosed with diabetic ketoacidosis (DKA)? A. The kidneys produce excess urine and the lungs try to compensate. B. The respirations increase the amount of carbon dioxide in the bloodstream. C. The lungs speed up to release carbon dioxide and increase the pH. D. The shallow and slow respirations will increase the HCO3 in the serum.
Intimacy vs. Isolation
Young Adulthood 18-40 yrs.
Hgb
[m] 13-18 [f] 12-16
HDL
[m] 35-70 [f] 35-85
RBC
[m] 4.6-6.2 million [f] 4.2-5.4 million
Creatine Kinase
[m] 50-235 [f] 20-250
ESR
[m] <15 [f] (<50yrs) <25 (>50yrs) <30
Acetaminophen Antidote
acetylcysteine (Mucomyst)
serum creatinine
adult-0.7-1.4 mg/dl
-mycin, -cin
aminoglycoside Interfer with protein synthesis of bacteria
-cycline, -floxacin
antibiotic
-arin
anticoagulant herarin prevent clot formation by decreasing vit. K levels and blocking the clotting chain, preventing platelet aggregation SE: bleeding, hematuria, dermatitic prutitis, fever
-asine
antiemetic compazine
-zine
antihistamine SE: extrapyramidal effects, drowsiness, sedation, orthostatic hypotension, dry mouth, photosensitivity
-statin
antilipidemic lowers cholesterol and triglycerides to decrease the potential for CVA atorvastatin/Lipitor SE: rash, alopecia, dyspepsia, muscle weakness, headache.
-tidine
antiulcer decreases acid production by blocking histamine 2 receptor sites SE: confussion, brady/tachycardia, psychosis, seizures
-vir
antivirus SE: N/V/D, oliguria, proteinuria, vaginitis, CNS side effects, tremors, confussion, seizures, severe sudden anemia
Mcburnies
appendix
Granulocytes
are blood cells that destroy bacteria
decreased PT is noted in what conditions?
arterial occlusion, deep vein thrombosis, edema, myocardial infarction, peripheral vascular disease, & pulmonary embolism.
resp ac
asthma atelacsis overvent from a vent
-pam, -lam, -pane
benzodiazepine antidote: flumazenil (Romazicon) anxiety/anticonvulsant diazepam/Valuim lorazepam/Ativan SE: drowsiness, lethargy, ataxia, depression, restlessness, slurred speech, bradycardia, hypotension, diplopia
-olol, -lol
betablocker blocks sympathetic motor response lowers BP, P, and cardiac output. Tx: migraine headache, glaucoma, prevent MI Propanolol/Inderal SE: orthostatic hypertension, bradycardia, N/V, diarrhea Monitor: BP and HR Instruct to stand slowly
Post op risks
bleeding, pain, swelling be concerned with what is not expected
Blood transfussions
blood can be 24 hrs. old use 18 gauge needle must be chilled fill drip chamber to level above the filter to prevent hyperkalemia (from bloods droplets falling and breaking)
Januvia (monitor)
blood glucose type 2 diabetes, controls blood sugar levels
before 5 mo.
brings hands together looks for items dropped grasps rattle
-phylline
bronchodilators asthma or colds dilate large air passages SE: tachycarida (common), more productive cough
Magnesium Antidote
calcium gluconate (Kalcinate)
CKMB
cardiac indicator for damage
What is the schilling test used to determine?
cause of the Vitamin B12 deficiency
airborne/contact precautions
chickenpox (varicella), herpes Zoster (shingles)
Nausea/Vomiting diet
clear liquids
around 2 mo.
coos
-asone, -solone
corticosteriod Monitor: wound healing
Levaquin (monitor)
culture and sensitivity antibiotic-bacterial infections of skin, sinuses, kidneys, bladder, prostate
Iron Antidote
deferoxamine (Desferal)
Elevated hematocrit levels are seen in pts w?
dehydration, pernicous anemia, or polycythemia
HDL-high density lipids
desirable greater than 40 mg/dL for men 50 mg/dL for female Heaven-good
LDL-low density lipids
desirable less than 100 mg/dL Lousy-bad
Triglycerides
desirable less than 150 mg/dL less than 100 mg/dL if on medication
Total Serum Cholesterol
desirable less than 200 mg/dL; risk for cardiac or stroke event w/levels grater than 150 mg/dL is the target range for therapy & has been shown to be the cut point to decrease cv or arterial incidence
triglycerides
detect risk for atherosclerosis; 100-200 mg/dl (<100 if on meds)
Digitalis Antidote
digoxin immune FAB (Digibind)
A value lower than 10:1 would indicate
diminished urea concentration
What are the labratory indicators of hepatitis?
elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, & leukopenia.
serum alanine amino-transaminase (ALT)
elevation indicates liver damage, normal is 5-35
Left side of brain effects
emotions
-afil
erectile dysfunction
metabolic alk
excessive vomting diarhhea whole blood decreased amount of acid in blood
resp alk
fever hysteria hypoxic and pain
Benzodiazepine Antidote
flumazenil (Romazicon)
Murrphys
gall bladder
Cholecystitis diet
gallbladder Low fat fresh fruit, skim or 1% milk, brown rice, egg whites, skinless chicken or turkey, beans
BNP
good indicator of CHF; normal under 100 elevated = B
around 3 mo.
holds head up posterior frontanel closes
What are catecholamines
hormones produced by the adrenal glands, found on top of the kidneys and released into the blood during times of physical or emotional stress (dopamine, norepinephrine, and epinephrine) called adrenalin
NG suctioning
hyperkalemia/hypokalemia risk for alkalosis, electrolye imbalance potassium is more sensitive than sodium
Digoxin (monitor)
hypokalemia slows and strengthens HB
A value greater than 15:1 would indicate
inadequate renal function
CK-MB
increased in Myocardial infarction
right shift
increased number of mature neutrophils
C-Peptide
indicates amount of endogenous insulin formed
shift to the left
indicates an increased number of immature neutrophils or increased number of bands. This signals an acute infectious process.
erythrocyte sedimentation rate (ESR)
indicates inflammation; 0 to 20 mm/h
aspartate aminotransferase (AST)
indicates liver function; 8-20 units/L
Low calcium levels cause
irregular HR
Venous circulation
legs are elevated (could be DVT)
Arterial circulation
legs go in dependent position (could be intermittent claudication) legs down
Troponin T (cardiac enzyme)
less than 0.2 mg/L
Troponin
less than 0.6
LDL
less than 100 mg/dL
Oral glucose tolerance test normal result at fasting state?
less than 115 mg/dL
Oral glucose tolerance test normal result at 120 minutes?
less than 140 mg/dL at 120 minutes
Oral glucose tolerance test normal result at 30,60,90 minutes?
less than 200 mg/dL
total serum cholesterol
less than 200 mg/dL
High ammonia levels cause
lethargy, confusion, and liver disease
-caine
local anesthetic loridacaine
Diverticulitis diet
low fiber NO seeds, white rice, pasta, tender meat, poultry, fish, eggs, milk, canned or cooked fruits w/o skin, seeds or membranes small pouches are formed in the esophagus, stomach & small intestine but the most common is in the Lg. intestine
Bilirubin
lower than 1.5
LDL
lower than 130 "lonely lipid"
TRIs
lower than 200
hemoglobin (Hgb)
man 13-18 g/dL woman 12-16 g/dL
red blood cell count (RBC)
man 4.6-6.2 million/mm^3 woman 4.2-5.4 million/mm^3 child 3.2-5.2 million/mm^3
HDL
man greater than 40 mg/dL woman greater than 50 mg/dL
airborne precautions
measles, TB
albumin
measures long term protein depletion; maintains osmotic pressure; 3.5-5.5 mg/dL
hematocrit (Hct)
measures percentage of RBCs per fluid volume of blood; man 42-52%; woman 35-47%
What is the antinuclear test?
measures the titer of antibodies that destroy the nuclei of cells and cause tissue death
droplet precautions
meningococcal disease, rubella
prothrombin time (PT)
monitors effectiveness of coumadin therapy; detects coagulation disorders; 9.5-12.0 seconds
partial thromboplastin time (PTT)
monitors effectiveness of heparin therapy; detects coagulation disorders; lower limit: 20-25 sec; upper limit: 32-39
Zyprexa (monitor)
mood antipsychotic schizophrenia, bipolar
HDL
more then 60 mg/dl
Opioid Antidote
naloxone (Narcan)
Hypovolemia
needs to pump blood faster (tachycardia)
urine RBC
negative
urine glucose
negative
INR
normal 0.9-1.2
Triponin
normal: less then 0.6, bed:more then 1.4 ng/ml
-ide
oral hypoglycemic
Warfarin Sodium Antidote
phytonadione (Vit. K)
Prednisone (monitor)
poor wound healing corticosteriod suppresses immune system, anti-inflammatory, allergies
Heparin Sodium Antidote & Enoxaparin/Lovenox
protamine sulfate
-prazole
proton pump inhibitor Tx GERD, gastric ulcers SE: hyperglycemia,headache, insomnia, diarrhea, flatulance, rash Monitor: glucose levels
CK-MM
reflects injury to the skeletal muscle
what is the differential count?
reflects the percentage of the total of white blood cells.
What does an elevated BUN level indicate?
renal failure dysfunction
Morphine (monitor)
respiration rate opioid/narcotic moderate to severe pain relief
droplet/contact precautions
respiratory syncytial virus
5-6 mo.
rolls over transfers between hands
ANC (absolute neutrophil count)
segs + bands (#WBC/100) < or = 1 means put on neutropenic precautions
Ambien (monitor)
sleep patterns sedative/hypnotic insomnia
12 mo.
stands alone nests object inside another
Lead Poisoning Antidote
succimer (Chimet)
Tylenol (monitor)
temperature pain reliever and fever reducer
elevated hematocrit levels measure?
the percentage of red blood cells in whole blood
-ase
thrombolytic
-tyline
tricyclic antidepressant
characteristics of epiglottitis
tripod position, tachycardia, drooling
Bilirubin Direct
up to 0.4 mg/dL
Bilirubin Total
up to 1.0 mg/dL
Bacteria
urinalysis = less than 1000 colonies/mL
platelet count
used to diagnose hemorrhagic diseases, thrombocytopenia; 150,000-450,000/mm^3
8-9 mo.
uses pincer grasp bangs toys together sits up on own
Positive FANA fluorescent antinuclear antibody test results
value greater than 1.8 will be present.
BUN
values affected by protein intake, tissue breakdown, fluid volume changes; 7-18 mg/dl; over 60 yrs 8-20 mg/dl
PTT
Lower: 20-25 seconds Upper: 32-39 (heparin)
INR
1.0 2-3 (A-fib, DVT, PE Therapy) 2.5-3.5 (pros. heart valves) (coumadin therapy)
Creatinine Clearance
1.67-2.5mL/s (eval. renal funct., 24hr collection, blood draw for CR level taken at end)
LDH (lactate dehydrogenase)
100-225 units/L (liver enzyme)
Ammonia
15-40 mcg/dL (detect liver disorder, no smoking before test)
Platelets
150,000-450,000/mm3
HbA1C
2.5-6%
Amylase
6-160 U/dL (Dx pancreatitis & acute cholecystitis - restrict food 1-2 hrs before & opiates 2 hrs before)
BUN
7-18mg/dL 8-20 (over 60) (values affected by protein intake, tissue breakdown, fluid volume changes)
ALT (alanine transaminase)
8-40 units (liver enzyme)
PT
9.5-12.0 seconds (coumadin)
Urine C&S
<100,000 colonies/mL
Total Cholesterol
<160mg/dL (if no CAD + <2 risk factors) <130 (if no CAD + 2 or more risk factors) <100 (if CAD present)
Lipase
<200 m/microliter (Dx acute & chronic pancreatitis, biliary obstruction, hepatitis, cirrhosis)
Schilling Test
>10% excreted w/in 24 hrs (radioactive B12 injected, low value indicates pernicious anemia)
CR (creatinine)
A: 0.7-1.4mg/dL C: 0.4-1.2 Infant: 0.3-0.6 (renal func., NPO 8hrs, list meds on lab slip)
WBC
Adult: 5,000-10,000/mm3 Child: 5,000-13,000
GTT (Glucose Tolerance Test)
Fasting: 60-110mg/dL 1hr: 190 2hr: 140 3hr: 125 (ability of body to secrete insulin in resp. to hyperglycemia)
Hgb
M: 13-18g/dL W: 12-16g/dL C (3-12): 11-12.5g/dL (amt. Hgb per 100 mL blood)
HDL
M: 35-70 mg/dL W: 35-85 (fast for 12-14 hours, determines if elev. chol. levels due to HDL or LDL)
RBC
M: 4.6 - 6.2 million/mm3 F: 4.2 - 5.4 C(3-12): 3.2 - 5.2
Hct
M: 42-52% W: 35-47% C(3-12): 35-45% (%RBC's per fluid vol.)
CK (creatinine kinase), CPK
M: 50-235 U/L W: 50-250 C: 0-70 (diagnose acute MI, injury/stress to heart/brain/muscles, detected in 3-5 hours)
ESR
M: <15mm/hr W<50: <25 W>50: <30 (indicates inflammation)
LDL:
Optimal: <139mg/dL Borderline: 140-160 High: >160 (Fast for 12-14 hours, determines if elev. chol. levels due to HDL or LDL)
Gastric Aspirate
pH <4
PTT
Activated Partial thromboplastin time. 60-70 seconds (Desired ranges are 1.5 - 2 x's normal on anti-coag meds) CRITICAL VALUE > 100 seconds = body cant clot or too much anti-coag therapy.
Given for type 2 diabetes
Actos
Albumin is decreased in what conditions?
Acute infection, ascites, alcoholism, burns, & cirrhosis.
Hyperkalemia is noted in what conditions?
Addison disease, adrenocortical insufficiency, anemia, burns, & ketoacidosis
Disease(s) with ↓ aldosterone
Addisons (can lead to shock r/t Na+ and H₂O excretion)
Identity vs. Role Confusion
Adolescence 12-18 yrs.
3.5-5.5
Albumin
Hypomagnesium Causes
Alcoholism GI suction Diarrhea Intestinal fistulas Poorly controlled DM (diabetes) Malabsorption syndrome
A. weight loss.
An elderly woman was admitted to the medical unit with dehydration. A clinical indication of this problem is A. weight loss. B. full bounding pulse. C. engorged neck veins. D. Kussmaul respiration.
C. "The sodium level is low, and the confusion will resolve as the levels normalize."
An older adult client admitted with heart failure and a sodium level of 113 mEq/L is behaving aggressively toward staff and does not recognize family members. When the family expresses concern about the client's behavior, the nurse would respond most appropriately by stating A. "The client may be suffering from dementia, and the hospitalization has worsened the confusion." B. "Most older adults get confused in the hospital." C. "The sodium level is low, and the confusion will resolve as the levels normalize." D. "The sodium level is high and the behavior is a result of dehydration."
A pt's lab shows antibody to surface antigen what does this mean?
Anti-HBs is a marker for the response to the vaccine and indicates immunity to hep B.
80-120
Apical Pulse 1-3 years of age
55-90
Apical Pulse 12-20 years of age
70-110
Apical Pulse 3-6 years of age
60-100
Apical Pulse 6-12 years of age
110-160
Apical Pulse Newborn
Given for metastatic renal cell carcinoma
Avastin
GERD diet
Avoid Lg. meals, eating late, alcohol, and caffeine
Celiac diet
Avoid glutens starches, natural flavorings, wheat
Gout diet
Avoid purines anchovies, organ meats, fish/sea food, yeast and yeast products (breads)
92-55
BP 1-3 years of age
121/70
BP 12-20 years of age
95/57
BP 3-6 years of age
107/64
BP 6-12 years of age
120/80
BP Adult
73/55
BP newborn
8-25
BUN
A nurse aid asks a RN why does urine needs to be refrigerated? The RN knows that when urine is allowed to stand unrefrigerated
Bacteria and White blood cells decompose
50,000
Bleeding occurs platelets under what number?
EKG changes with Hyperkalemia
Bradycardia, Tall peaked T waves, Prolonged PR intervals, Flat/absent P waves, Widened QRS, Conduction blocks, V-Fib
S/Sx of Hypercalcemia
Brittle Bones, Kidney stones, ↓DTR, ↓ Muscle tone, ↓LOC, Arrhythmia, ↓ pulse, ↓ respiration
contact precautions
C. diff, herpes simplex, salmonella, shingellosis, staphylococcus, VRE, Hep. A when fecal incontinence is present
0-5
CK-MB (Creatine Kinase-Cardiac Muscle
8.6-10
Calcium
Antidote for Magnesium Toxicity
Calcium Glutonate... *Administer slowly (MAX rate = 1.5 2 mL/min)
>12
Calcium High Critical
<7
Calcium Low Critical
-dipine
Calcium channel blocker Tx: high BP, migranes, Raynauds Monitor: BP and HR
When are increased red blood cells seen in what conditions?
Cardiac output, impaired pulmonary gas exchange, corticosteroid therapy, polycythemia vera, severe diarrhea, and dehydration.
Purpose of ANP
Causes excretion of Na+ and H₂O
Report to CDC
Chlamydia (STD) Meningitis (droplet) HIV (STD) Tuberculosis (airborne)
98-107
Chloride
Hypernatremia is noted in what conditions?
Congestive heart failure, cushing's disease, dehydration, diabetes insipidus, diaphoresis, diarrhea, & hypovolemia
ESR is useful for what particular type of disease?
Connective tissue disease.
0.6-1.3
Creatinine
26
Creatinine Kinase (CK)
Disease(s) with ↑ aldosterone
Cushings (↑ in all steroids) Hyperalderstonism (Conns)
Given for depression
Cymbalta
<10
D Dimer
Hypermagnesium Nursing Management
D/c oral and IV Mg Emergency: support ventilation & IV calcium gluconate Hemodialysis Monitor reflexes Teach re: OTC Rx containing Mg Monitor respiratory status Monitor cardiac rhythm; have calcium preps available to antagonize cardiac depressant
Stages of grieving
DABDA denial anger bargaining depression acceptance
metabolic ac
DKA malnutrion diarrhea excessive amt of asa
Increase or decrease in hemoglobin in Iron Deficiency anemia?
Decrease hemoglobin level.
Liver Disease diet
Decrease protein intake apples, apricots, bananas, black and blueberries, cooked cabbage, raw spinich, & raw cucumbers
Hypermagnesium S&S
Depresses the CNS Depresses cardiac impulse transmission Cardiac arrest Facial flushing Muscle weakness Absent deep tendon reflexes Paralysis Shallow respirations
Given to lower blood pressure
Diovan
Hydorchlorothiazide
Diuretic Watch for electrolyte problem
D. 0.45% Sodium chloride
Dry mucous membranes are a clinical sign of dehydration. Weight loss can be associated with dehydration but is not a confirming sign. Engorged neck vessels and bounding pulse are signs of fluid overload. The nurse anticipates that the physician will order which intravenous (IV) fluid for a client who is dehydrated? A. Ringer's lactate B. 3% Sodium chloride C. 0.9% Sodium chloride D. 0.45% Sodium chloride
0-20
ESR Female Normal
0-13
ESR Male Normal
What would serum studies of a pt with glomerulonephritits look like?
Elevated levels of BUN, Creatinine, C-Reactive protein, and antistreptolysin O titer
Hypernatremia S&S
Elevated temp Weakness Disorientation Irritability and restlessness Thirst Dry, swollen tongue Sticky mucous membranes Hypotension Tachycardia
Given to slow the progression of arthritis
Enbrel
What are BUN and Cr levels do?
Evaluate renal function.
Convert Fahrenheit to Celsius
F - 32/1.8 = C
Hemoglobin
F: 12-16 gm M: 14-18 gm
Hematocrit
F: 37-48% M: 42-52%
GTT (Glucose Tolerance Test)
Fasting: 60-110 mg/dL 1hr: 190 mg/dL 2hr: 140 mg/dL 3hr: 125 mg/dL
Glucose
Fasting=70-110 (60-100)
S/Sx of Hypermagnesemia
Flushing, Warmth, Vasodilation, ↓DTR, ↓ Muscle tone, ↓LOC, Arrhythmia, ↓ pulse, ↓ respiration
14-34
Folic Acid
b. K
Furosemide inhibits reabsorption of sodium, water, and K leading to diuresis. ** The most common electrolyte disturbance associated with furosemde admin is hypokalemia Nurse inserts a nasogastric tube, and it immediately drains 1000 mL of fluid. Which of the follwoing electrolyte level is of greatest concern at this time? a. Na b. K c. Cl d. CO2
2 classic signs of glomerulonephritis
Gross hematuria and proteinuria
12-18
HBG Hemoglobin
22-27
HCO3 (up or down = Metabolic)
PTT Partial Thromboplastin Time
HEPARIN Lower limit: 20-25sec Upper Limit: 32-39
<7%
HbA1c, measurement of amount of glycated or glycosylated hemoglobin, evaluating average blood glucose level over the past 120 days. Good control value:
<6%
HbA1c, measurement of amount of glycated or glycosylated hemoglobin, evaluating average blood glucose level over the past 120 days. Normal value:
>8%
HbA1c, measurement of amount of glycated or glycosylated hemoglobin, evaluating average blood glucose level over the past 120 days. Poor control value:
37-52
Hematocrit (3x hgb) - Average
35-47
Hematocrit Female
40-52
Hematocrit Male
12-15
Hemoglobin Female
14-16.5
Hemoglobin Male
What serum lab result detects the development of a chronic carrier state in a pt w/ hepatitis?
Hepatitis B surface antigen
Default Order
Hold, Assess, Prepare, Call, DO
Hypernatremia causes
Hypertonic tube feedings w/out water supplements Hyperventalation Diabetes insipidus Ingestion of OTC Rx such as Alka-Seltzer Inhaling large amounts of saltwater (near drowning) Inadequate water ingestion
d. wound dehisience
Hypocalcemia causes excitability of skeletal, cardiac, and smooth muscle tissues. Evidence of this is seen in the Trousseau sign, a carpopedal spasm. The WBC count of a client is 18,000. the nurse attributes this value to which of the following health problems of this client? a. arthritis b. alcoholism c. viral infection d. wound dehisience
d. Hypocalcemia
Hypokalemia is almost universal complication of loss of gastric hydrochloric acid. Metabolic alkalosis results. Other electrolytes may be affected, but not to the degree of potassium homeostasis is altered. The nurse should observe for a Trousseau sign in the client with which of the following electrolyte abnormalities? a. Hypokalemia b. Hyponatremia c. Hypochloremia d. Hypocalcemia
Hypocalcium Causes
Hypoparathyroidism Pancreatitis (precipitates calcium as a soap) Renal failure Steroids and loop diuretics Inadequate intake Post-thyroid surgery
Coumadin (monitor)
INR anticoagulant reduces formation of clots, prevents heart attack, strokes, blood clots
2-3
INR on Coumadin (123)
Hypercalcium Nursing Management
IV admin of 0.45% NaCl or 0.9% NaCl Encourage fluids Lasix Calcitonin - decreases calcium level Mobilizing the pt Dietary calcium restriction Injury prevention Limit intake of calcium carbonate antacids
Hypernatremia Nursing Management
IV admin of hypotonic solution Offer fluids at regular intervals Decrease sodium in diet Daily weight
A. osmosis.
If the blood plasma has a higher osmolality than the fluid within a red blood cell, the mechanism involved in equalizing the fluid concentration is A. osmosis. B. diffusion. C. active transport. D. facilitated diffusion.
A. fluid
Implementation of nursing care for the patient with hyponatremia includes A. fluid restriction. B. administration of hypotonic IV fluids. C. administration of a cation exchange resin. D. increased water intake for patients on nasogastric suction.
Serum Amylase level difference in Acute & Chronic Pancreatitis
In acute pancreatitis, the value may excees 5 times the normal. In chronic pancreatitis, the value does not usually exceed three times the normal value.
Nursing Management to prevent renal calculi (hypercaclcium)
Increase fluid intake Maintain acidic urine Prevent urinary tract infection
Hypomagnesium Nursing Management
Increase intake of Mg (green veggies, nuts, bananas, oranges, peanut butter, chocolate) Parenteral admin of supplements: magnesium sulfate Oral: long term mngmnt w/ oral magnesium IV: assess renal fx Monitor for digitalis toxicity (Rx ADR) Seizure precautions Safety measures for confusion Test ability to swallow pre PO fluids/food b/c of dysphagia
Increase or decrease in hemoglobin in Dehydration?
Increase the hemoglobin by hemoconcentration.
Increase or decrease in hemoglobin in heart failure or COPD?
Increase the hemoglobin level as a result of the body's need for more oxygen carrying capacity.
Hypomagnesium S&S
Increased neuromuscular irritability Tremors Tetany Hyperactive deep tendon reflexes Seizures Dysrhythmias especially if hypokalemia present Disorientation Confusion
C. 65-year-old client recently diagnosed with congestive heart failure
Individuals taking potassium-wasting diuretics are at risk for hypokalemia. Evaluating blood glucose level when the client reports weakness is important to ensure that low blood glucose level is not an issue. Levels of the other substances would not be affected by a potassium-wasting diuretic. The following four clients are all at risk for fluid volume excess. Which of the clients should the nurse see first? A. 88-year-old client with a fractured femur scheduled for surgery B. 20-year-old client with a 5-year history of type 1 diabetes mellitus C. 65-year-old client recently diagnosed with congestive heart failure D. 50-year-old client with second-degree burns on the ankles and feet
How does bed rest help with fluid volume overload
Induces diuresis → By releasing ANP and ↓ production of ADH
What conditions may cause decreased platelet aggregation?
Infectious mononucleosis, idiopathic thrombocytopenia purpura, acute leukemia, von Willebrand's disease
Increased iron binding capacity & increased transferrin saturation indcate?
Iron deficiency anemia
C. positive Chvostek's sign
It is especially important for the nurse to assess for which of the following in a patient who has just undergone a total thyroidectomy? A. weight gain B. depressed reflexes C. positive Chvostek's sign D. confusion and personality changes
Aldactone, Spirolactone
K+ sparing Diuretic Watch K+
Therapeutic dose of heparin for treatment of DVT.
Keep aPTT between 1.5 and 2.5 times the normal.
Hypercalcium S&S
Lack of coordination Anorexia, N & V Confusion, decreased LOC Personality changes Dysrhythmias, heart block, cardiac arrest
Integrity vs. Despair
Late Adulthood 65 yrs. to death
Erythrocyte Sedimentation Rate
Less than 20 mm/hr CBC
Cholesterol
Less than 225 mg/dL (for age 40-49 yr; increases with age)
How long do platelets normally aggregate?
Less than 5 minutes
Carbon Monoxide
Less than 5% of total hemoglobin
Decreased values of hematocrit levels occur in what conditions?
Leukemia, acute hemorrhage, iron deficiency anemia, and hemolytic anemia
Given to prevent heart disease
Lipitor
Burmetanide (Bumex)
Loop diuretic
Normal Troponin I level
Lower than 0.6 ng/mL
Given for neuropathy
Lyrica
Myoglobin (cardiac enzyme)
M: 20-90 ng/ml F: 12-75 ng/ml
CPK (cardiac enzyme)
M: 5-35 mcg/ml (38-174 units/L) F: 5-25 mcg/ml (26-140 units/L)
GGT
M: 5-85 units/L F: 5-55 units/L
iron
M: 70-175 mcg/dl F: 65-175 mcg/dl
alkaline phosphotase
M: 98-521 units/L F: 81-234 units/L
1.6-2-6
Magnesium
>3.0
Magnesium High critical
<0.5
Magnesium low critical
Hct-hematocrit
Male 42-52% Females 37-47%
Hct
Male= 42-52% or 0.42 - 0.52 Female= 37-47% or 0.37 - 0.47
Creatinine
Male=0.6 - 1.2 mg/dL Female=0.5 - 1.1 mg/dL
Hgb
Male=14-18 g/dL Female=12-16 g/dL
RBC
Male=4.7- 6.1 Female=4.2 - 5.4
Serum Creatinine
Males 0.6-1.2 mg/dL Females 0.5-1.1 mg/dL Renal function
Hgb
Males 14-18 g/dL Females 12-16 g/dL CBC
RBC's
Males 4.7-6.1 mm3 Females 4.2-5.4 mm3 CBC urinalysis = negative
Hypercalcium Causes
Malignant neoplastic diseases Hyperprathyroidism Prolonged immobilization excessive intake Immobility Excessive intake of calcium carbonate antacids
a. hand washing
Many factors are intially controlled for the IV insertion procedure. This nurse understands this begins with: a. hand washing b. checking sterility of supplies c. 6 med rights d. checking IV order
What does it mean to measure the ESR?
Measuring the ESR can confirm inflammation or infection anywhere in the body
Generativity vs. Stagnation
Middle Adulthood 40-65 yrs.
Tx for Hypercalcemia
Move - weight bearing causes Ca to leave blood enter bones, ↑ Fluids to ↓ kidney stones, phosphorus, Calcitonin (↓ serum Ca)
S/Sx of Hypokalemia
Muscle Cramps, weakness → Life threatening arrhythmia
S/Sx of Hyperkalemia
Muscle twitching → weakness → flaccid paralysis → Life threatening arrhythmia
<90
Myoglobin
Pancreatits diet
NPO, TPN may be used Produces enzymes that help digestion and hormones that help regulate the way the body processes glucose
Hyponatremia S&S
Nausea Muscle cramps Confusion Muscular twitching, coma Seizures Headache
Hypocalcium S&S
Nervous system becomes increasingly excitable Tetany (Trousseau's sign & Chvostek's sign) Hyperactive reflexes Confusion Paresthesias Irritability Seizures
Given for GERD
Nexium
60-100
Normal Apical Pulse Adult
12-20
Normal Respirations Adult
d. K = 3.2
Nurse would be most concerned about which lab values obtained fro ma client receiving furosemide (Lasix) therapy? a. BUN 20 b. K 3.4 c. Creatinine 1.1 d. K 3.2
95-100
O2 Sat
d. Infant
One of the most common electrolyte imbalances is: Hypokalemia The client most at risk for fluid volume defecit (FVD) is: a. Elder adult b. Adult c. Child d. Infant
b. Have a decreased thirst sensation
One reason older adults experience fluid and electrolyte imbalance and acid-base imbalances, is they: a. Eat poor quality foods b. Have a decreased thirst sensation c. have more stress response d. have an overly active thirst response
Lantus
Onset: 1-2 hrs. Peak: 0 peak Duration: 10.5-24 hrs lonely lantus
Humulin N, NPH 70/30
Onset: 1-2 hrs. Peaks: 4-12 hrs. Duration: 18-24 hrs. Cloudy
Humulin R, Regular
Onset: 1/2-1 hr. Peaks: 2-3 hrs. Duration: 5-7 hrs. Admin: 30 min AC (b4 meal) Clear
Lispro, Humalog
Onset: less than 15 min. Peaks: 1/2 -1 hr. Duration: 3-4 hrs. Admin: 5-15 min. AC (b4 meal)
LDL
Optimal: <139 Borderline: 140-160 High: >160
Hyponatremia Nursing Management
Oral admin of Na+ rich foods (beef broth, tomato juice) IV LR or high concentrations of NaCl (0.9%) Water restriction (safer method) I & O Daily weight
Hypocalcium Nursing Management
Orally - calcium gluconate or calcium chloride (w/ OJ to maximize absorption) Parenterally - calcium gluconate Increase dietary intake of calcium Calcium supplements Regular exercise Administer phosphate-binding antacids, calcitriol, vit D
a. client teaching
Output recorded on an I/O sheet would be all of these: Urine Diarrhea Vomit Gastric suction Wound drainage Health promotion activities in the area of fluid and electrolyte imbalance focus primarily on: a. client teaching b. dietary intake c. medication d. physician involvement in care
7.35 - 7.45
PH
<7.35
PH = Acidosis
>7.45
PH=Alkalosis
11-12.5
PT Normal
Heparin (monitor)
PTT anticoagulant prevents clot formation, prevents clots in veins, arteries, and lungs
60-70 Sec
PTT Normal (takes a minute)
90-140 Sec
PTT on Heparin (1-1 1/2 times longer)
35-45
PaCO2 (up or down = Respiratory)
80-100
PaO2
aPTT
Partial thromboplastin time. 30-40 seconds (Desired ranges are 1.5 - 2 x's normal on anti-coag meds) CRITICAL VALUE > 70 seconds = body cant clot or too much anti-coag therapy.
2.7-4.5
Phosphorus
150,000-450,000
Plateletes
Given to prevent an MI or stroke
Plavix
3.5-5.1
Potassium
3.5-5.1
Potassium (K)
>6.5
Potassium High Critical
<2.5
Potassium Low Critical
Initiative vs. Guilt
Preschool 3-5 yrs.
R O M E
R = PaCO2 O = pH (opposite) ___________________ M = HCO3 E = pH (equal) both Vomit and Diarrhea are metabolic disorders (only determine if it is alka or acid)
120 Days
RBC Lifespan
4.5-5.6M
RBC's in adult
Hypermagnesium Causes
Renal failure Excessive Mg admin (antacids, cathartics)
20-30
Respirations 1-3 years of age
12-20
Respirations 12-20 years of age
16-22
Respirations 3-6 years of age
16-20
Respirations 6-12 years of age
30-60
Respirations Newborn
Puropose of Aldosterone
Retain H₂O and Na+
S/Sx of Hypomagneseima
Rigid muscle tone, Siezures, Laryngospasm/Stridor, + Chovstek, + Trouseeau, Arrythmia, ↑DTR, Excitable mindset, Swallowing problems.
hyponatremia (Na+)
Risk: GI loss, SIADH, adrenal insufficiency, diuretics, water intoxication, decrease intake Manifestations: less than 135 mEq/L, weakness, lethargy, confusion, seizures, coma, HI or Low will effect the brain not the heart Interventions: monitor for confusion & seizures, Daily wt., assess CNS changes, I&O, administer IVF (hypertonic - acute or isotonic- restore volume), seizure precautions, teach sodium rich food, if etiology is FVE-restrict fluids, RISK with hypertonic solutions is cerebral edema
hypomagnesemia (Mg++)
Risk: GI loss, alcoholism, diuretics, pancreatitis, hypocalcemia, hypokalemia, insulin resistance, DKA Manifestations: less than 1.8 mEq/L, tetany, cramps, increased DTR's, paresthesias, dysrhythmias, trousseau's sign, chvostek's sign, agitation, confusion Interventions: seizure precautions, assess for difficulty swallowing, correct underlying cause, IV magnesium, teach food sources, MONITOR for signs of magnesium toxicity with IV replacement and treat with calcium
Hypokalemia (K+)
Risk: GI loss, diuretics, aminoglycosides, decrease intake Manifestations: Less than 3.5 mEq/L, muscle weakness and fatigue, N/V, dysrhythmia, flat T waves Intervention: ECG monitor, administer K+, teach dietary sources of K+, NEVER give K+ IV bolus it must be diluted HINT: NO P no K
hypophosphatemia
Risk: alcoholism, chronic diarrhea, starvation, vit. D deficiency Manifestations: less than 2.5 mg/dL, muscle weakness, decreased DTRs, hypercalciuria/renal stones, dysrhythmias, confusion, anxiety, lethargy/coma Interventions: correct etiology, oral phosphate replacement, vit. D, decrease calcium level
hypercalcemia (Ca++)
Risk: hyperparathyroidism, malignant disease, prolonged immobilization, vit. D excess, thiazide diuretics, lithium Manifestations: greater than 10 mg/dL, muscle weakness, decreased DTRs, hypercalciuria/renal stones, dysrhythmias, confusion, anxiety, lethargy/coma Interventions: increase mobility, isotonic IVF, furosemide, calcitonin, glucocorticoids, biophosphonates, INCREASE RISK of fractures
hypocalcemia (Ca++)
Risk: hypoparathyroidism, hypomagnesemia, renal failure, vit. D deficiency, loop diuretics, phenytoin Manifestations: less than 8.5 mg/dL, tetany, cramps, parasthesias, dysrhythmias, trousseau's sign, chvostek's sign, seizures Intervenstions: seizure precautions, IV calcium replacement, daily calcium supplements, CALCIUM has inverse relationship with PHOSPHORUS
hyperphosphatemia
Risk: renal failure, chemotherapy, high vit. D, high phosphorus intake, excessive enema use (fleet's) Manifestations: greater than 4.5 mg/dL, tetany, cramps, paresthesias, dysrhythmias, trousseau's sign, chvostek's sign, seizures Interventions: aluminum hydroxide (with meals), decrease dialysis (RF), PHOSPHORUS has inverse relationship with CALCIUM
hypermagnesemia (Mg++)
Risk: renal failure, excessive Mg++ therapy, adrenal insufficiency, laxative abuse Manifestations: greater than 3.0 mEq/L, hypotension, drowsiness, decreased DTRs, bradycardia, bradypnea, coma, cardiac arrest Interventions: decrease intake, IV calcium gluconate, mechanical ventilation, temporary pacemakes
Hyperkalemia (K+)
Risk: tissue injury, K+ sparing diuretics, renal failure, adrenal insufficiency, increase intake Manifestations: greater than 5.0 mEq/L, muscle cramps, weakness, paralysis, bradycardia, dysrhythmias, tall T waves Interventions: ECG monitor, kayexalate, 50% glucose with insulin, calcium gluconate, loop diuretics, dialysis, BS assessment with Kayexalate
hypernatremia (Na+)
Risk: water deficit, GI loss, DI, increase intake Manifestations: greater than 145 mEq/L, thirst, dry mucous membranes, restless, weak, orthostatic hypotension, muscle irritability, seizures, coma Intervention: daily wt, assess CNS changes, I&O, administer IVF (isotonic-restore volume), seizure precautions, teach food sources
-pram, -ine
SSRI
Industry vs. Inferiority
School age 5-12 yrs.
Given for bipolar disorder
Seroquel
Elevated hemoglobin S indicates?
Sickle cell anemia
Given for asthma
Singulair
Dumping Syndrome diet
Sm. frequent meals, low fiber, high fat and protein Avoid liquids @ meal time
135-145
Sodium
>160
Sodium High Critical
<130
Sodium Low Critical
1.016 - 1.022
Specific Gravity
What is urine specific gravity?
Specific gravity evaluates the kidney's ability to regulate fluid balance & evaluate the hydration status of th ebody.
Foods high in Mg
Spinach, Mustard greens, Summer squash, broccoli, halibut, pumpkin seeds, turnip greens, cucumber, sunflower seeds, sesame seeds, flax seeds.
Given for bronchospasm
Spiriva
What conditions may cause platelet aggregation to occur?
Surgery, acute illness, venous thrombosis, pulmonary embolism
A. 56-year-old client with acute renal failure
The 65-year-old client with congestive heart failure is at the greatest risk for problems from fluid volume excess. Fluid overload in this client could quickly cause life-threatening problems. The 50-year-old client with second degree burns is at risk for fluid volume deficit. The nurse assesses four clients. Which client is at greatest risk for the development of hypocalcemia? A. 56-year-old client with acute renal failure B. 40-year-old client with systemic lupus erythematosus C. 28-year-old client who has just undergone a total thyroidectomy D. 65-year-old client with hypertension taking beta-adrenergic blockers
Platelet aggregation
The adherence of platelets to one another.
C. 2000 mL
The client diagnosed with diabetes insipidus weighed 180 pounds when the daily weight was taken yesterday. This morning's weight is 175.6 pounds. One liter of fluid weighs approximately 2.2 pounds. How much fluid has the client lost (in milliliters)? A. 500 mL B. 1000 mL C. 2000 mL D. 4400 mL
C. Serum potassium.
The client has been vomiting and has had numerous episodes of diarrhea. Which laboratory test should the nurse monitor? A. Serum calcium. B. Serum phosphorus. C. Serum potassium. D. Serum sodium.
B. Discontinue the intravenous line.
The client has received IV solutions for three (3) days through a 20-gauge IV catheter placed in the left cephalic vein. On morning rounds the nurse notes the IV site is tender to palpation and a red streak has formed. Which action should the nurse implement first? A. Start a new IV in the right hand. B. Discontinue the intravenous line. C. Complete an incident record. D. Place a warm washrag over the site.
A. Place the solution on an IV pump at the prescribed rate. B. Monitor blood glucose every six (6) hours. E. Monitor intake and output every shift.
The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? Select all that apply. A. Place the solution on an IV pump at the prescribed rate. B. Monitor blood glucose every six (6) hours. C. Weigh the client weekly, first thing in the morning. D. Change the IV tubing every three (3) days. E. Monitor intake and output every shift.
C. Dehydration.
The client is admitted to a nursing unit from a long-term care facility with a hematocrit of 56% and a serum sodium level of 152 mEq/L. Which condition would be a cause for these findings? A. Overhydration. B. Anemia. C. Dehydration. D. Renal failure.
D. Place on seizure precautions.
The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented? A. Encourage fluids orally. B. Administer 10% saline solution IVPB. C. Administer antidiuretic hormone intranasally. D. Place on seizure precautions.
B. Tap the cheek about two (2) centimeters anterior to the ear lobe.
The client post-thyroidectomy complains of numbness and tingling around the mouth and the tips of the fingers. Which intervention should be implemented first? A. Notify the health care provider immediately. B. Tap the cheek about two (2) centimeters anterior to the ear lobe. C. Check the serum calcium and magnesium levels. D. Prepare to administer calcium gluconate IVP.
C. On auscultation, crackles and rales in all lung fields are noted.
The client who has undergone an exploratory laparotomy and subsequent removal of a large intestinal tumor has a nasogastric tube (NGT) in place and an IV running at 150 mL/hr via an IV pump. Which data should be reported to the health care provider? A. The pump keeps sounding an alarm that the high pressure has been reached. B. Intake is 1800 mL, NGT output is 550 mL, and Foley output 950 mL. C. On auscultation, crackles and rales in all lung fields are noted. D. Client has negative pedal edema and an increasing level of consciousness.
C. Dry mucous membranes
The client with acute renal failure is at the highest risk of hypocalcemia. While the patient who underwent a thyroidectomy is at risk, the client with acute renal failure is at a higher risk. Clinical assessment of dehydration would be confirmed if the nurse identified: A. 1-lb weight loss B. Engorged neck vessels C. Dry mucous membranes D. Full bounding radial pulse
A. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load
The lungs act as an acid-base buffer by A. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. B. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load. C. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. D. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.
C. Instruct the client on appropriate fluid restrictions.
The nurse and an unlicensed nursing assistant are caring for a group of clients. Which nursing intervention should the nurse perform? A. Measure the client's output from the indwelling catheter. B. Record the client's intake and output on the I & O sheet. C. Instruct the client on appropriate fluid restrictions. D. Provide water for a client diagnosed with diabetes insipidus.
A. calcium supplements.
The nurse anticipates that the patient with hyperphosphatemia secondary to renal failure will require A. calcium supplements. B. potassium supplements. C. magnesium supplements. D. fluid replacement therapy.
D. Hypocalcemia
The nurse assesses a client to be experiencing muscle cramps, numbness, and tingling of the extremities, and twitching of the facial muscle and eyelid when the facial nerve is tapped. THe nurse reports this assessment as consistent with which of the following? A. Hypokalemia B. Hypernatremia C. Hypermagnesemia D. Hypocalcemia
A. Baked cod D. Baked potato E. Spinach
The nurse assists a client with a serum potassium of 3.2 mEq/L to make which of the following menu selections? Select all that apply. A. Baked cod B. Ham and cheese omelet C. Fried eggs D. Baked potato E. Spinach
A. 50-year-old with pneumonia, diaphoresis, and high fevers
The nurse evaluates which of the following clients to be at risk for developing hypernatremia? A. 50-year-old with pneumonia, diaphoresis, and high fevers B. 62-year-old with congestive heart failure taking loop diuretics C. 39-year-old with diarrhea and vomiting D. 60-year-old with lung cancer and syndrome of inappropriate antidiuretic hormone (SIADH)
C. A client who has renal failure, takes antacids, and has a magnesium level of 2.9 mEq/L
The nurse evaluates which of the following clients to have hypermagnesemia? A. A client who has chronic alcoholism and a magnesium level of 1.3 mEq/L B. A client who has hyperthyroidism and a magnesium level of 1.6 mEq/L C. A client who has renal failure, takes antacids, and has a magnesium level of 2.9 mEq/L D. A client who has congestive heart disease, takes a diuretic, and has a magnesium level of 2.3 mEq/L
A. acute renal failure.
The nurse is admitting a client with a potassium level of 6.0 mEq/L. The nurse reports this finding as a result of A. acute renal failure. B. malabsorption syndrome. C. nasogastric drainage. D. laxative abuse
A. Provide passive ROM exercises and encourage fluid intake
The nurse is caring for a bedridden client admitted with multiple myeloma and a serum calcium level of 13 mg/dl. Which of the following is the most appropriate nursing action? A. Provide passive ROM exercises and encourage fluid intake B. Teach the client to increase intake of whole grains and nuts C. Place a tracheostomy tray at the bedside D. Administer calcium gluconate IM as ordered
B. Question the results and redraw the specimen
The nurse is caring for a client who has been in good health up to the present and is admitted with cellulitis of the hand. The client's serum potassium level was 4.5 mEq/L yesterday. Today the level is 7 mEq/L. Which of the following is the next appropriate nursing action? A. Call the physician and report results B. Question the results and redraw the specimen C. Encourage the client to increase the intake of bananas D. Initiate seizure precautions
C. An increase in blood pressure
The nurse is caring for a client with congestive heart failure. On assessment, the nurse notes that the client is dyspneic and that crackles are audible on auscultation. The nurse suspects excess fluid volume. What additional signs would the nurse expect to note in this client if excess fluid volume is present? A. Weight loss B. Flat neck and hand veins C. An increase in blood pressure D. A decreased central venous pressure (CVP)
C. Needs changing because it is beyond the 3-day recommended limit
The nurse is conducting an assessment of a client receiving intravenous (IV) fluids via a central line. Today is March 9. The tubing is dated March 5. The nurse determines that the tubing: A. Is good for 3 more days, for a total of 7 days B. Can remain in place as long as there is not a disconnection C. Needs changing because it is beyond the 3-day recommended limit D. Needs changing, along with the IV port, because they have been in place for 4 days
D. A client with dehydration and a sodium level of 149 mEq/L
The nurse is evaluating the serum laboratory results on the following four clients. Which of the following laboratory results is a priority for the nurse to report first? A. A client with osteoporosis and a calcium level of 10.6 mg/dl B. A client with renal failure and a magnesium level of 2.5 mEq/L C. A client with bulimia and a potassium level of 3.6 mEq/L D. A client with dehydration and a sodium level of 149 mEq/L
A. Peas C. Cauliflower E. Canned white tuna
The nurse provides instructions to a client with a low magnesium level about the foods that are high in magnesium and tells the client to consume which foods? Select all that apply. A. Peas B. Oranges C. Cauliflower D. Peanut butter E. Canned white tuna
B. Take aluminum-based antacids such as aluminum hydroxide (Amphojel) with or after meals
The nurse should include which of the following instructions to assist in controlling phosphorus levels for a client in renal failure? A. Increase intake of dairy products and nuts B. Take aluminum-based antacids such as aluminum hydroxide (Amphojel) with or after meals C. Reduce intake of chocolate, meats, and whole grains D. Avoid calcium supplements
B. A client who is alcoholic receiving total parenteral nutrition
The nurse should monitor for clinical manifestations of hypophosphatemia in which of the following clients? A. A client with osteoporosis taking vitamin D and calcium supplements B. A client who is alcoholic receiving total parenteral nutrition C. A client with chronic renal failure awaiting the first dialysis run D. A client with hypoparathyroidism secondary to thyroid surgery
B. Restrict the client's sodium in the diet.
The nurse writes the nursing problem of "fluid volume excess" (FVE). Which intervention should be included in the plan of care? A. Change the IV fluid from 0.9% NS to D5W. B. Restrict the client's sodium in the diet. C. Monitor blood glucose levels. D. Prepare the client for hemodialysis.
A. Hypokalemia
The physician has ordered that a client with hypertension begin receiving a thiazide diuretic. The nurse will now closely monitor the client for: A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypermagnesemia
A. A client who has been experiencing diarrhea and has a serum chloride level of 100 mEq/L
The registered nurse is delegating client assignments to unlicensed assistive personnel. Which of the following clients does not require additional monitoring and assessment and may be delegated to unlicensed assistive personnel? A. A client who has been experiencing diarrhea and has a serum chloride level of 100 mEq/L B. A client with renal failure who has a serum magnesium level of 3.0 mEq/L C. A client who has experienced a fracture of the femur and has a serum phosphate of 5.0 mg/dl D. A client with dehydration who has a serum sodium level of 128 mEq/L
C. Obtain a glucose level on a client admitted with diabetes mellitus
The registered nurse is delegating nursing tasks for the day. WHich of the following tasks may the nurse delegate to a licensed practical nurse? A. Assess a client for metabolic acidosis B. Evaluate the blood gases of a client with respiratory alkalosis C. Obtain a glucose level on a client admitted with diabetes mellitus D. Perform a neurological assessment on a client suspected of having hypocalcemia
A. The client in normal sinus rhythm with a peaked T wave.
The telemetry monitor technician notifies the nurse of the morning telemetry readings. Which client should the nurse assess first? A. The client in normal sinus rhythm with a peaked T wave. B. The client diagnosed with atrial fibrillation with a rate of 100. C. The client diagnosed with a myocardial infarction who has occasional PVC. D. The client with a first-degree AV block and a rate of 92.
What does the glycosylated hemoglobin A1C test measure?
The test measures the amount of glucose that has become permanetly bound to the red blood cells from circulating glucose. This test is useful in identifying pts who have periods of hyperglycemia that are undetected in other ways.
B. hypotonic.
The typical fluid replacement for the patient with an ICF fluid volume deficit is A. isotonic. B. hypotonic. C. hypertonic. D. a plasma expander.
B. Seals the end of the syringe and places it in a cup of crushed ice water
Thiazide diuretics cause the loss of water and potassium through the kidneys. Thus, if the client is not consuming sufficient potassium in the diet, a hypokalemic state could occur. Hypokalemia can cause muscle weakness and dysrhythmias. Hyponatremia is not usually a problem because there is an abundance of sodium in the body and the additional regulation of sodium by aldosterone would compensate for sodium loss due to diuretics Calcium level would be unaffected by thiazide diuretics. If magnesium were to be affected by thiazide diuretics, it would be excreted along with potassium, but the imbalance would be hypomagnesemia, not hypermagnesemia. The nurse is assisting a physician in obtaining a sample for blood gas analysis from a client's left wrist. After drawing the sample into the syringe, the nurse: A. Adds a drop of heparin to the sample to prevent clotting B. Seals the end of the syringe and places it in a cup of crushed ice water C. Places the syringe of blood in a dark bag to protect the specimen from light D. Seals the syringe in a zip-lock bag and places the specimen in the out box for laboratory pickup
B. intracellular
Tissue injury can cause an increase in WBC The majority of the body's water is contained in which of the following fluid compartments? A. interstitial B. intracellular C. extracellular D. intravascular
What is a more sensitive indicator of protein status? Albumin or Transferrin
Transferrin
<0.6
Troponin 1(Cardiac muscle >1.5 = MI
>0.1-0.2
Troponin T
What lab tests best evaluates the kidney's ability to regulate fluid balance?
Urine specific gravity
Indirect Coombs test
Used to detect circulating antibodies against RBCs
Given to treat herpes zoster
Valtrex
When are decreased red blood cell amounts seen in what conditions?
Vitamin B6 and B12 deficiencies, iron deficiency, chronic infection, bone marrrow depression, multiple myeloma, leukemia,hemolytic anemia, and pernicious anemia.
Hyponatremia Causes
Vomiting Diuretics Excessive administration of dextrose and water IVs Burns, wound drainage Excessive water intake SIADH
PT Prothrombin Time
WARFARIN 9.5-12.0 seconds
4,500-11,000
WBC's Normal
BMI
Weight in lbs divided by (height in inches) x (height in inches)= ?# and multiply by 703 OR Weight in kg divided by (height in meters) x (height in meters) 1 meter = 39 inches Under weight - less than 18.5 Normal - 18.5-24.9 Over weight - 25-29.9 Obesity - 30 or greater
