Exam 2: 280

11. A patient's anion gap is 15 mEq/L. Which condition below can cause this lab result?* A. Diabetic Ketoacidosis B. Hypokalemia C. Over usage of antacids D. Vomiting

A A normal anion gap is 3-10 mEq/L. An anion gap assesses for an acid-base imbalance by looking at certain electrolytes from the metabolic panel (sodium, chloride, bicarbonate) and if there is a gap or difference between positively and negatively charge electrolytes. A HIGH gap or difference demonstrates metabolic acidosis such as Diabetic Ketoacidosis. All the other options actually cause alkalosis.

1. The physician orders a Basic Metabolic Panel (BMP) on your patient. You know this blood test will assess all of the following EXCEPT? Select all that apply:* A. Bilirubin B. Sodium C. Glucose D. ALP (alkaline phosphatase) E. AST (aspartate transaminase) F. Potassium G. Calcium H. BUN I. Creatinine J. Total Protein K. CO2 L. Albumin M. Chloride N. Globulin O. ALT (alanine transaminase)

A D E J L N O

9. A patient is post-op from a parathyroidectomy. A CMP is drawn. The nurse will be monitoring the patient for?* A. Hypocalcemia B. Hypercalcemia C. Hyperglycemia D. Hypoglycemia

A The parathyroid gland regulates calcium levels. Therefore, if the parathyroid is removed (parathyroidectomy) there is a risk of HYPOcalcemia (low calcium levels).

3. Your patient has liver disease. On assessment you note that your patient has an orangish/yellowish hue to their skin and the sclera of the eyes. In addition, you note that the patient's urine is orange in color. What lab result on the CMP correlates with these findings?* A. ALP 50 U/L B. Creatinine 1 mg/dL C. Bilirubin 3 mg/dL D. Albumin 4 g/dL

A normal Bilirubin is 0.1-1 mg/dL. Bilirubin is a waste product from the breakdown of RBCs. When RBCs breakdown it creates an orangish/yellowish substance. This breakdown is mainly performed in the liver, and this substance from the RBCs is normally excreted in the bile, which is then excreted in the stool. This substance gives stool it brown color and very little Bilirubin should be in the urine. If too much is in the blood it will leak into skin and mucous membranes along with the urine

10. Which lab results on the Comprehensive Metabolic Panel (CMP) measures the complete amount of proteins in the blood such as albumin and globulin?* A. Bilirubin B. Total Protein C. AST (aspartate transaminase) D. Anion Gap

B A normal total protein is 6.2-8.2 g/dL and it measures the complete amount of proteins in the blood such as albumin and globulin.

8. Which result below represents hypercalcemia?* A. Potassium 7 mEq/L B. Potassium 2.2 mEq/L C. Calcium 9 mg/L D. Calcium 15 mg/L

D A normal calcium level is 8.5-10.5 mg/L. Hypercalcemia is a HIGH calcium level.

5. The CMP ordered on your patient shows that the patient's potassium level is 6.5 mEq/L. How do you interpret this potassium level, and which option below could cause this type of potassium level?* A. This potassium level is within normal limits. B. Hypokalemia; loop diuretics C. Hyperkalemia; Cushing's Syndrome D. Hyperkalemia; ACE Inhibitors

D A normal potassium level is 3.5-5 mEq/L. A level of 6.5 mEq/L is known as HYPERkalemia. Causes of hyperkalemia include: renal failure, medications: ACE inhibitors, potassium-sparing diuretics, Addison's Disease (causes low aldosterone production which causes the kidneys to keep more potassium, which increase's blood levels).

7. ____________ is a protein made in the liver that plays a vital role in regulating oncotic pressure inside the blood vessel. Your patient's level is 1 g/dL and this is considered to be: LOW or HIGH?* A. Globulin; LOW B. Bilirubin; HIGH C. AST (aspartate transaminase); HIGH D. Albumin; LOW

D Albumin is a protein made in the liver that plays a vital role in regulating oncotic pressure inside the blood vessel. A normal albumin level is 3.4-5.4 g/dL and a level of 1 g/dL is considered LOW.

4. True or False: A normal estimated glomerular filtration rate (eGFR) is <60.* True False

False A normal estimated glomerular filtration rate (eGFR) is >60 (NOT <60). This is an estimation of how well the glomerulus in the kidney is filtering water, ions, and water from the blood to create urine. The eGFR is determined by many factors such as the patient's creatinine level, age, sex, and race.

7. A patient's platelet count is 300,000. You would interpret this result as?* A. Normal B. Abnormal: thrombocytopenia C. Abnormal: thrombocytosis

The answer is A. A normal platelet count range is 150,000-400,000.

2. The patient has been fasting overnight and arrives to the lab where a CMP is collected. CMP results show that the patient's glucose is 98 mg/dL. This result is interpreted as?* A. Euglycemic B. Hypoglycemic C. Hyperglycemic

The answer is A. Euglycemic means normal glucose level. A normal glucose is 70-100 mg/dL, if fasting. If NOT fasting a normal glucose is 70-125 mg/dL.

5. A patient is prescribed Warfarin (Coumadin) for the treatment of a blood clot. What is the therapeutic INR range for this medication to be effective? A. 2-3 B. 1-3 C. 4-8 D. 0.5-2.5

The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation....(ex: up to 4.5)

6. What is an approximate normal range for a PT (prothrombin) level? A. 10-12 seconds B. 2-3 seconds C. 30-40 seconds D. 60-80 seconds

The answer is A: 10-12 seconds (varies among labs).

1. A patient is ordered a PT/INR blood test. As the nurse you know that this blood test assesses? A. Extrinsic pathway of coagulation and common pathways B. Intrinsic pathway of coagulation and common pathways C. Clotting factors XII, XI, IX, VIII D. Only clotting factor II (prothrombin)

The answer is A: Extrinsic pathway of coagulation and common pathways. The PT/INR assesses the extrinsic pathway of coagulation (which uses clotting factor VII) and common pathways (which uses factor I, II, V, X). The extrinsic pathway is activated when there is outside/external injury that results in blood loss from the vascular system.

4. __________ represents the average size of red blood cells on the CBC result.* A. MCV (Mean Corpuscular Volume) B. MCHC (Mean Corpuscular Hemoglobin Concentration) C. MCH (Mean Corpuscular Hemoglobin) D. RDW (Red Cell Distribution)

The answer is A: MCV (mean corpuscular volume) is the average size of the RBCs.

3. A patient's complete blood count (CBC) results are back. Which result demonstrates polycythemia?* A. RBC 10 million B. WBC 15,000 C. Platelets 600,000 D. RBC 2.5 million

The answer is A: Polycythemia is an increase in RBCs. Normal range for RBC 4.5-5.5 million.

7. Your patient, who is prescribed Warfarin for blood clots, has an INR of 1. As the nurse you know that this means? A. The medication is therapeutic. B. The medication is not effective at preventing blood clots. C. The patient is at risk for bleeding. D. The patient is experiencing Warfarin toxicity.

The answer is B. A therapeutic INR for a patient taking Warfarin should be 2-3. Therefore, the patient's medication is not effective at this time for preventing blood clots.

5. Your patient is a 39-year-old male. What is considered a normal Hemoglobin level for this patient?* A. 35% B. 17 g/dL C. 11 g/dL D. 50%

The answer is B. Normal Hgb for men: 14-18 g/dL and women: 12-16 g/dL.

3. What is the approximate normal range for an aPTT result? A. 2-3 second B. 30-40 seconds C. 1.5-2.5 times the normal range D. 10-12 seconds

The answer is B: 30-40 seconds (This range varies among labs).

2. Your patient is being evaluated for a bleeding disorder. The physician orders an aPTT blood test. Which statement is TRUE about this coagulation test? A. The aPTT is an important result used to assess the effectiveness of Warfarin. B. The aPTT assesses the intrinsic pathway of coagulation and common pathways. C. The aPTT is measured in milliseconds. D. The aPTT only assesses clotting factor VII.

The answer is B: The aPTT assess the intrinsic pathway of coagulation and common pathways. The aPTT assesses the intrinsic pathway of coagulation and common pathways. Therefore, clotting factors I, II, V, X (which are part of common pathways) and clotting factors XII, XI, IX, VIII (which are part of intrinsic pathway) are assessed. The intrinsic pathway is activated when there is inside injury within the vascular system. The aPTT is an important result used to assess the effectiveness of Heparin (NOT Warfarin), and it's measured in SECONDS (not milliseconds).

4. A patient is receiving continuous IV Heparin. In order for this medication to have a therapeutic effect on the patient, the aPTT should be? A. 0.5-2.5 times the normal value range B. 2-3 times the normal value range C. 1.5-2.5 times the normal value range D. 1-3.5 times the normal value range

The answer is C. An aPTT should be 1.5-2.5 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the aPTT is too low, blood clots can form. If the aPTT is too high, bleeding can occur.

8. A patient's complete blood count (CBC) with differential shows an elevated Eosinophil count at 10%. As the nurse you know the Eosinophils ____________?* A. fight viral infections B. fight bacterial infections C. play a role in allergic reactions and parasitic infections D. play a role in clotting

The answer is C. Eosinophils play a role in allergic responses/reactions and parasitic infections.

6. You're assessing the red blood cell indices on the complete blood count (CBC). What part of the indices represents the concentration of Hgb on the RBC?* A. MCV B. MCH C. MCHC D. RDW

The answer is C: MCHC (mean corpuscular hemoglobin concentration)

10. Your patient's aPTT level is 32 seconds. The nurse would interpret this lab result as? A. Too high, the patient is at risk for bleeding. B. Too low C. Normal

The answer is C: Normal...an approximate normal range for an aPTT is about 30-40 seconds.

8. Fill in the blank: Prothrombin turns into _________ with the assistance of clotting factor V. A. fibrinogen B. fibrin C. thrombin D. vitamin K

The answer is C: Thrombin....Prothrombin turns into thrombin by clotting factor V. When thrombin is on board it is responsible for turning fibrinogen to fibrin. Fibrin is one of the main ingredients for clot formation.

1. You're assessing the patient's complete blood count (CBC). Which lab result below demonstrates leukopenia?* A. WBC 7,000 B. Platelets 90,000 C. WBC 3,000 D. Platelets 500,000

The answer is C: WBC range is 5,000-10,000. Leukopenia is a DECREASED white blood count

10. Which lab result on a patient's record from the complete blood count (CBC) represents thrombocytopenia?* A. Platelets 275,000 B. WBC 3,000 C. WBC 15,000 D. Platelets 80,000

The answer is D. A normal platelet count range is 150,000-400,000. Thrombocytopenia means a LOW platelet count.

9. Which result in the complete blood count (CBC) reflects the protein found on the red blood cell that helps carry oxygen throughout the body?* A. MCH B. RDW C. Hct D. Hgb

The answer is D: Hgb (hemoglobin)

2. A patient had a complete blood count (CBC) with differential test ordered. You asses the white blood cell count results and know that this laboratory test will also assess the count of what other types of WBCs? Select all that apply:* A. Thrombocytes B. Neutrophils C. Lymphocytes D. Eosinophils E. Erythrocytes F. Basophils G. Monocytes

The answers are B, C, D, F, and G. Neutrophils, lymphocytes, eosinophils, basophils, and monocytes are the 5 different types of white blood cells.

9. A patient's PT result is 30 seconds. What conditions below could cause this result? Select all that apply: A. None, this is a normal PT range. B. Vitamin K deficiency C. Liver disease D. Warfarin

The answers are B, C, and D. All of these could increase the PT level (a normal range is approximately 10-12 seconds).

6. A patient's morning BMP results are back with the following results: Glucose 93 mg/dL, Calcium 8.5 mg/L, Sodium 115 mEq/L, Chloride 100 mEq/L, Potassium 7 mEq/L, CO2 30 mEq/L, BUN 40, Creatinine 3 mg/dL. Which labs results are abnormal? Select all that apply:* A. Glucose B. Calcium C. Sodium D. Chloride E. Potassium F. CO2 G. BUN H. Creatinine

sodium, potassium, BUN, and creatinine are abnormal