Question 1

Which of the following findings indicates a severe feature of pre-eclampsia?

Accepted Answer

Answer reason: AST of 140 (greater than twice normal) indicates hepatic involvement, a severe feature of preeclampsia. The other findings do not meet severe criteria: normal creatinine, only 1+ proteinuria, BP not ≥160/110, and uric acid is not a defining criterion.

Question 2

When is pre-eclampsia first suspected in a pregnant woman?

Accepted Answer

Answer reason: Proteinuria (albuminuria) on routine urine testing is an abnormal, specific indicator of preeclampsia and prompts suspicion earlier than nonspecific findings like edema, weight gain, or BP fluctuations.

Question 3

A client is prescribed digoxin for heart failure. What is the therapeutic range for digoxin?

Accepted Answer

Answer reason: Therapeutic serum digoxin levels are generally considered 0.5–2.0 ng/mL; toxicity risk increases above 2.0 ng/mL. Of the choices, 1.0–2.0 ng/mL best represents the accepted therapeutic range.

Question 4

Which of the following findings would confirm diagnosis of 'severe' pre-eclampsia?

Accepted Answer

Answer reason: Severe features of preeclampsia include impaired liver function with transaminases ≥2× normal. An AST of 140 is markedly elevated, confirming a severe feature. The other findings are normal or not at severe thresholds (Cr 0.8 normal; 1+ proteinuria not severe; BP 158/96 is below ≥160/110; uric acid 5.8 is not a diagnostic severe criterion).

Question 5

What is the therapeutic plasma level range of digoxin?

Accepted Answer

Answer reason: Therapeutic serum digoxin levels are commonly cited around 0.8–2.0 ng/mL; among the options, 1.2–2 ng/mL best represents the therapeutic range, while >2.4 ng/mL suggests toxicity.

Question 6

The nurse is caring for a client following a myocardial infarction. Which of the following enzymes are specific to cardiac damage?

Accepted Answer

Answer reason: CK-MB is specific for myocardial injury, whereas CK-BB is brain-specific and SGOT (AST) and total LDH are not cardiac-specific. Among the options, the pair that includes the cardiac-specific isoenzyme is LDH and CK-MB.

Question 7

A adult client has had laboratory work done as part of a routine physical examination. The nurse interprets that the client may have a mild degree of renal insufficiency if which of the following serum creatinine levels is noted?

Accepted Answer

Answer reason: Normal adult serum creatinine is about 0.6–1.3 mg/dL. A value of 1.9 mg/dL is mildly elevated, suggesting mild renal insufficiency, whereas 3.5 mg/dL indicates more severe impairment and 0.2–0.5 mg/dL are low/normal.

Question 8

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?

Accepted Answer

Answer reason: A sudden critical rise in K+ from 4.5 to 7 mEq/L in an otherwise healthy client is likely spurious (e.g., hemolyzed sample). The priority is to question the result and obtain a redraw to verify before notifying the provider or initiating treatments.

Question 9

The nurse is caring for a 4-year-old who will have surgery for Tetralogy of Fallot tomorrow. Which laboratory report must receive PRIORITY attention by the nurse?

Accepted Answer

Answer reason: Tetralogy of Fallot causes chronic hypoxemia leading to erythropoietin-driven polycythemia. Elevated hemoglobin/hematocrit increases blood viscosity and perioperative risk, so H/H requires priority review.

Question 10

After assessing a 70 year-old male client's laboratory results during a routine clinic visit, which one of the following findings would indicate an area in which teaching is needed?

Accepted Answer

Answer reason: Albumin of 2.5 g/dL is below the normal 3.5–5.0 g/dL and suggests poor nutrition or other pathology, warranting education. Glucose 90 mg/dL and RBCs 5.0 million/mm3 are normal; LDL 140 mg/dL is borderline but not the most immediate teaching priority here.

Question 11

A prenatal client has a suspected diagnosis of iron deficiency anemia; which finding should the nurse expect to note on assessment?

Accepted Answer

Answer reason: Iron deficiency anemia results in decreased hemoglobin synthesis, leading to a reduced hemoglobin level. Dehydration or overhydration may alter lab concentration but are not defining findings of iron deficiency anemia. A high hematocrit would contradict the diagnosis.

Question 12

The nurse is reviewing the lab results of four clients. Which finding should be reported to the physician?

Accepted Answer

Answer reason: A WBC of 3,800/mm3 is leukopenia, which increases infection risk and can reflect bone marrow suppression, including medication-related effects in clients treated for seizures. The other findings are consistent with the stated conditions (elevated creatinine in chronic renal failure, positive CRP with inflammation, and elevated hematocrit with dehydration from gastroenteritis). Therefore, the leukopenia warrants provider notification.

Question 13

A 4-year-old is scheduled for a routine tonsillectomy. Which of the following lab findings should be reported to the doctor?

Accepted Answer

Answer reason: A WBC of 16,000/mm3 is elevated and may indicate infection; elective surgery is commonly postponed when an active infection is suspected to reduce perioperative risk. Hemoglobin 12 g/dL, platelets 200,000/mm3, and urine specific gravity 1.010 are within expected limits for many children. Thus, the elevated WBC is the finding to report.

Question 14

Which laboratory values would a nurse expect to be elevated in a patient diagnosed with liver cirrhosis?

Accepted Answer

Answer reason: Cirrhosis commonly impairs bilirubin conjugation and excretion, leading to elevated serum bilirubin and jaundice. Albumin is typically decreased due to impaired hepatic synthesis. PT is typically prolonged (increased time) due to reduced clotting factor production, but it is not usually described as an “elevated value” in the same way as a concentration. ALT may be normal or only mildly elevated in advanced cirrhosis compared with acute hepatitis.

Question 15

The glycosylated hemoglobin of a 40-year-old client with diabetes mellitus is 2.5%. The nurse understands that?

Accepted Answer

Answer reason: HbA1c reflects average glucose over ~2–3 months; typical targets for most nonpregnant adults are

Question 16

The nurse is reviewing the lab reports on several clients. Which one should be reported to the physician immediately?

Accepted Answer

Answer reason: A WBC of 2,200/cu mm is severe leukopenia and places the client at high risk for infection; it may indicate medication-related bone marrow suppression and requires urgent provider notification. The other findings are expected or explainable in context (elevated creatinine in chronic renal failure, positive CRP in inflammatory disease, and elevated hematocrit with dehydration). Immediate action is most appropriate for profound leukopenia.

Question 17

A client is admitted to the acute care unit. Initial laboratory values reveal serum sodium of 170 mEq/L. What behavior changes would be most common for this client?

Accepted Answer

Answer reason: Severe hypernatremia (Na+ 170 mEq/L) causes significant neurologic dysfunction due to cellular dehydration in the brain, leading to confusion, delirium, agitation, and potentially hallucinations. Among the choices, psychosis best reflects severe altered mental status. Anger, mania, and depression are less specific for an acute, severe electrolyte derangement.

Question 18

When assessing a client for risk of hyperphosphatemia, which piece of information is most important for the nurse to obtain?

Accepted Answer

Answer reason: Neck radiation can damage the parathyroid glands, leading to hypoparathyroidism. Low PTH decreases renal phosphate excretion, resulting in hyperphosphatemia. The other factors may affect overall health but are not primary, classic risks for elevated phosphate.

Question 19

Today's prothrombin time for a client receiving Coumadin is 20 (normal range listed by the lab is 10-14). What is the APPROPRIATE nursing action?

Accepted Answer

Answer reason: A PT of 20 seconds is prolonged compared with the lab normal and may or may not be therapeutic depending on the client’s target INR/indication; the safest nursing response is to assess the client for bleeding while correlating with INR and orders. Simply assuming it is therapeutic can miss over-anticoagulation. Immediate provider notification may not be necessary without bleeding or a critically high INR, but focused bleeding assessment is appropriate.

Question 20

Which adaptations should the nurse expect a client with diabetic ketoacidosis to exhibit?

Accepted Answer

Answer reason: Diabetic ketoacidosis causes metabolic acidosis. The primary physiologic compensation is hyperventilation (Kussmaul respirations), which lowers PaCO2. Option A is incorrect because sweating is not the characteristic acid–base compensatory response. Option C is incorrect because retinopathy is a chronic diabetes complication, not an acute DKA adaptation.

Question 21

A client being treated with sodium warfarin has an INR of 8.0. Which intervention would be most important to include in the nursing care plan?

Accepted Answer

Answer reason: An INR of 8.0 indicates severe over-anticoagulation and high risk for bleeding; the priority is to assess for bleeding (gums, urine/stool, bruising, hypotension). Option B is incorrect because increasing the dose would further increase bleeding risk. Option D is incorrect because neuro checks alone are too narrow and do not address overall bleeding risk.

Question 22

A client receiving heparin therapy for deep vein thrombosis has a PTT of 120 seconds. The nurse’s priority action is to?

Accepted Answer

Answer reason: A PTT of 120 seconds is above typical therapeutic range and increases bleeding risk; the safest priority action is to stop/hold the infusion per protocol and notify the provider. Option A is incorrect because continuing at the same rate maintains excessive anticoagulation. Option C is incorrect because increasing the rate would further prolong PTT and increase hemorrhage risk.

Question 23

A client with heart failure is prescribed digoxin. What is the therapeutic serum level of digoxin?

Accepted Answer

Answer reason: Common NCLEX reference range for therapeutic digoxin level is 0.5–2.0 ng/mL. Option C is incorrect because levels above 2.0 ng/mL are associated with toxicity risk. Option D is incorrect because 5.0–10.0 ng/mL is far above therapeutic and represents severe toxicity.

Question 24

What is the normal range for prothrombin time (PT) in blood clotting tests?

Accepted Answer

Answer reason: Normal PT is approximately 11–13 seconds, so 11–12 seconds is within the expected range. Option A is incorrect because 25–35 seconds corresponds to aPTT, not PT. Option D is incorrect because PT is measured in seconds, not minutes.

Question 25

A client has autoimmune thrombocytopenic purpura. To determine the client's response to treatment, the nurse would monitor?

Accepted Answer

Answer reason: Immune thrombocytopenic purpura is defined by thrombocytopenia; improvement is shown by an increasing platelet count. Option B is incorrect because WBC count does not measure thrombocytopenia treatment response. Option D is incorrect because PTT evaluates coagulation factor pathways, not platelet number.

Question 26

A client with Addison's disease has been admitted with a history of nausea and vomiting for the past 3 days. The client is receiving IV glucocorticoids (Solu-Medrol). Which of the following interventions would the nurse implement?

Accepted Answer

Answer reason: Addison’s disease is associated with hyponatremia and hyperkalemia, and vomiting increases risk for electrolyte imbalance; sodium and potassium monitoring addresses the most immediate lab-related risk. Option A is incorrect because glucose monitoring may be needed with steroids, but it does not address the classic, potentially life-threatening electrolyte derangements of Addison’s. Option D is incorrect because weights can help assess volume status but do not directly identify dangerous sodium/potassium abnormalities.

Question 27

A client being treated with sodium warfarin (Coumadin) has a Protime of 120 seconds. Which intervention would be most important to include in the nursing care plan?

Accepted Answer

Answer reason: A PT of 120 seconds indicates marked over-anticoagulation and high hemorrhage risk; the priority is assessment for bleeding. Option B is incorrect because increasing warfarin would worsen bleeding risk. Option C is incorrect because teaching is important but not the immediate priority with critically prolonged clotting time.

Question 28

Twenty-four hours after an uncomplicated labor and delivery, a client's WBC is 12,000 cu/mm. The elevation in the client's WBC is most likely an indication of?

Accepted Answer

Answer reason: Mild leukocytosis is common in the first 24 hours postpartum due to physiologic stress; 12,000/mm3 can be expected. Option B is incorrect because the stem states uncomplicated delivery and the value alone is not specific for infection. Option D is incorrect because dehydration does not reliably cause leukocytosis as the primary explanation for this postpartum finding.

Question 29

While reviewing the chart of a client with a history of hepatitis B, the nurse finds a serologic marker of HBsAg. The nurse recognizes that the client?

Accepted Answer

Answer reason: Presence of HBsAg indicates current hepatitis B infection; in a client with a history of HBV, ongoing HBsAg suggests chronic infection/carrier state. Option B is incorrect because recovery is associated with anti-HBs, not persistent HBsAg. Option D is incorrect because HBsAg positivity indicates potential infectivity.

Question 30

The client with acute renal failure has serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action?

Accepted Answer

Answer reason: Potassium 6.0 mEq/L indicates hyperkalemia with risk for life-threatening dysrhythmias; continuous cardiac monitoring is the priority safety action. Option C is incorrect because many vegetables are high in potassium and could worsen hyperkalemia. Option D is incorrect because extra fluids will not rapidly correct hyperkalemia and may be unsafe in renal failure.

Question 31

The client with acute renal failure has a serum potassium of 6.0 mEq/L. The nurse would plan which of the following as a priority action?

Accepted Answer

Answer reason: Hyperkalemia (K+ 6.0 mEq/L) can precipitate fatal dysrhythmias; priority is cardiac monitoring. Option A is incorrect because sodium level does not address the immediate dysrhythmia risk. Option C is incorrect because increasing dietary potassium can worsen the lab abnormality.

Question 32

A client with hypoparathyroidism complains of numbness and tingling in his fingers and around the mouth. The nurse would assess for what electrolyte imbalance?

Accepted Answer

Answer reason: Hypoparathyroidism decreases PTH, lowering serum calcium; perioral and fingertip paresthesias are classic manifestations of hypocalcemia. Option A is incorrect because hyponatremia typically causes headache, confusion, or seizures rather than perioral tingling. Option C is incorrect because hyperkalemia is associated with muscle weakness and dysrhythmias, not perioral tingling.

Question 33

The client with an abdominal aortic aneurysm is admitted in preparation for surgery. Which of the following should be reported to the doctor?

Accepted Answer

Answer reason: An elevated WBC suggests infection or inflammation that may increase perioperative risk and should be reported before surgery. Option B is incorrect because an abdominal bruit can be an expected finding with an aneurysm. Option D is incorrect because equal, reactive pupils are a normal assessment finding.

Question 34

The client is admitted with chronic obstructive pulmonary disease. Blood gases reveal pH 7.36, CO2 45, O2 84, bicarb 28. The nurse would assess the client to be in?

Accepted Answer

Answer reason: pH is low-normal (slightly acid), bicarbonate is elevated (28) indicating renal compensation, consistent with chronic respiratory acidosis in COPD. Option B is incorrect because alkalosis would have a higher pH. Option D is incorrect because metabolic acidosis would have a low bicarbonate, not elevated.

Question 35

A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6, WBC 6500, K+ 1.9, uric acid 7.0, Na+ 136, and platelets 178,000. The nurse evaluates that the client is experiencing which of the following?

Accepted Answer

Answer reason: Potassium 1.9 mEq/L is critically low, indicating hypokalemia. Option A is incorrect because sodium 136 mEq/L is within normal range. Option D is incorrect because WBC 6500/mm3 is normal and does not indicate leukocytosis.

Question 36

A client has been admitted for meningitis. In reviewing the laboratory analysis of cerebrospinal fluid (CSF), the nurse would expect to note?

Accepted Answer

Answer reason: Meningitis (especially bacterial) is associated with elevated CSF protein. Option D is incorrect because CSF glucose is typically decreased in bacterial meningitis. Option C is incorrect because sedimentation rate is a blood test, not a CSF lab parameter.

Question 37

A 57 year-old male client has a hemoglobin of 10 g/dL and a hematocrit of 32%. What would be the MOST appropriate follow-up by the home care nurse?

Accepted Answer

Answer reason: Low hemoglobin/hematocrit suggest anemia; the nurse should first assess for a common and potentially serious cause such as GI bleeding (dark stools). Option B is incorrect because the stem provides no signs of hemodynamic instability requiring emergency care. Option C is incorrect because waiting a month delays evaluation of a clinically significant abnormality.

Question 38

In a child with a right-to-left shunt, which finding should the nurse expect?

Accepted Answer

Answer reason: Right-to-left shunting causes chronic hypoxemia that stimulates erythropoiesis, resulting in elevated hematocrit (polycythemia). Option B is incorrect because peripheral edema is not the expected compensatory finding of a right-to-left shunt. Option D is incorrect because bounding pulses are more consistent with conditions like PDA, not right-to-left shunt compensation.

Question 39

A client is admitted with the diagnosis of Myocardial Infarction. Which of the following lab values would be consistent with this diagnosis?

Accepted Answer

Answer reason: Myocardial injury can elevate cardiac enzymes, including CK (CPK), particularly CK-MB. Option A is incorrect because albumin reflects nutrition/liver/kidney status, not acute MI. Option B is incorrect because high cholesterol is a risk factor, not a diagnostic marker of an acute infarction.

Question 40

A client in respiratory distress is admitted with arterial blood gas results of: PH 7.30; PO2 58, PCO 34; and HCO3 19. The nurse determines that the client is in?

Accepted Answer

Answer reason: The pH is low and the bicarbonate is low, indicating primary metabolic acidosis; the PaCO2 is low, consistent with respiratory compensation. Option C is incorrect because respiratory acidosis would have an elevated PaCO2. Option B is incorrect because metabolic alkalosis would have an elevated bicarbonate.

Question 41

A 70 year-old post-operative client has elevated serum BUN, Hct, Cl, and Na+. Creatinine and K+ are within normal limits. The nurse should perform additional assessments to confirm that an actual problem is?

Accepted Answer

Answer reason: Elevated sodium, chloride, hematocrit, and BUN with normal creatinine suggests hemoconcentration/dehydration rather than intrinsic renal failure. Option C is incorrect because renal insufficiency typically also elevates creatinine. Option A is incorrect because these labs do not directly indicate impaired gas exchange.

Question 42

A client's admission urinalysis shows the specific gravity value of 1.039. Which of the following assessment data would the nurse expect to find when assessing this client?

Accepted Answer

Answer reason: A high urine specific gravity indicates concentrated urine, commonly associated with dehydration; poor skin turgor is an expected dehydration finding. Option A is incorrect because dehydration typically causes dry mucous membranes. Option B is incorrect because urinary frequency is more consistent with dilute urine states, not concentrated urine.

Question 43

Which of the following laboratory results would suggest to the emergency room nurse that a client admitted after a severe motor vehicle accident is in acidosis?

Accepted Answer

Answer reason: Serum CO2 (a proxy for bicarbonate) of 20 mEq/L is low and suggests metabolic acidosis. Option A is incorrect because hemoglobin does not indicate acid–base status. Option B is incorrect because chloride 100 mEq/L is within normal limits and does not by itself indicate acidosis.

Question 44

A 36 year-old female client has a hemoglobin level of 14 g/dl and a hematocrit of 42% following a D&C. Which of the following would the nurse expect to find when assessing this client?

Accepted Answer

Answer reason: Hemoglobin 14 g/dL and hematocrit 42% are within expected adult female ranges, so normal perfusion findings are expected. Option B is incorrect because pale mucous membranes suggest anemia, which is not supported by the labs. Option D is incorrect because fatigue with ambulation is more consistent with anemia or hypoxia, not normal H/H.

Question 45

A nurse is precepting a student in the emergency room. A client is treated for diabetic ketoacidosis and a glucose level of 650 mg/dL. In assessing the client, the student's review of which of the following tests suggests an understanding of this health problem?

Accepted Answer

Answer reason: In DKA, total-body potassium is depleted and serum potassium can drop rapidly once insulin and fluids are given; monitoring potassium is critical. Option A is incorrect because calcium is not the primary acute lab priority specific to DKA management. Option C is incorrect because creatinine may be elevated from dehydration but does not guide urgent DKA electrolyte replacement like potassium.

Question 46

During a routine check-up, an insulin-dependent diabetic has his glycosylated hemoglobin checked. The results indicate a level of 11%. Based on this result, what teaching should the nurse emphasize?

Accepted Answer

Answer reason: HbA1c of 11% reflects poor long-term glycemic control and indicates a need for improved day-to-day glucose monitoring to guide therapy changes. Option A is incorrect because site rotation prevents lipodystrophy but does not directly address poor glycemic control. Option D is incorrect because a high-protein diet is not the primary teaching intervention for elevated HbA1c.

Question 47

A client on telemetry begins having premature ventricular beats (PVBs) at 12/minute. In reviewing the most recent laboratory results, which would require immediate action by the nurse?

Accepted Answer

Answer reason: Potassium 2.5 mEq/L is severe hypokalemia and can precipitate ventricular dysrhythmias, requiring immediate intervention. Option A is incorrect because calcium 9 mg/dL is within normal limits. Option D is incorrect because an elevated PTT does not explain PVCs and is not the immediate dysrhythmia trigger.

Question 48

Which condition is associated with decreased urine specific gravity?

Accepted Answer

Answer reason: Diabetes insipidus causes inability to concentrate urine, leading to dilute urine with low specific gravity. Option D is incorrect because dehydration causes concentrated urine and increases specific gravity. Option C is incorrect because glomerulonephritis often causes protein/blood in urine, which tends to increase specific gravity.

Question 49

The nurse is assisting in the care of a client with diverticulosis. Which of the following assessment findings must necessitate an immediate report to the doctor?

Accepted Answer

Answer reason: A hemoglobin of 8 g/dL with a corresponding hematocrit of approximately 24% indicates significant anemia, which may reflect active gastrointestinal bleeding in a client with diverticulosis and requires immediate provider notification.

Question 50

Which fasting plasma glucose level indicates that a patient has diabetes?

Accepted Answer

Answer reason: A fasting plasma glucose of 130 mg/dL meets the diagnostic threshold for diabetes (≥126 mg/dL, typically confirmed on repeat testing). Option A is incorrect because 100 mg/dL does not meet the diagnostic threshold for diabetes. Option D is incorrect because 69 mg/dL indicates hypoglycemia.

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