Q: The nurse is caring for a 17 month-old with acetaminophen poisoning. Which of the following lab reports should the nurse review FIRST?

Answer reason: Acetaminophen overdose primarily injures the liver, causing hepatocellular necrosis. Monitoring AST/ALT first assesses the extent of hepatic damage and guides urgent management.

Q: The nurse is assessing a 17 year-old female client with bulimia. Which of the following laboratory reports would the nurse anticipate?

Answer reason: Bulimia often involves vomiting and laxative/diuretic misuse, causing loss of potassium and resulting hypokalemia. The other options are not characteristic expected lab findings.

Q: A client is diagnosed with hyperkalemia. Which EKG abnormality is most characteristic of this condition?

Answer reason: The earliest and most characteristic ECG change in hyperkalemia is tall, narrow, “tented” peaked T waves caused by accelerated repolarization of cardiac cells. Although severe hyperkalemia can progress to wide QRS complexes, peaked T waves appear first and are the most specific early indicator.

Q: Which electrolyte imbalance is MOST associated with flattened T waves and the presence of U waves on ECG?

Answer reason: Low potassium levels slow ventricular repolarization, leading to flattened T waves and characteristic U waves on ECG.

Q: Which lab value indicates hypokalemia?

Answer reason: Normal serum potassium is about 3.5–5.0 mEq/L. Hypokalemia is defined as a potassium level below 3.5 mEq/L. Therefore, 3.2 mEq/L indicates hypokalemia. By contrast, 4.2 and 3.6 mEq/L are within normal range, and 5.6 mEq/L reflects hyperkalemia.

Q: The nurse is aware that the following laboratory values supports a diagnosis of pyelonephritis?

Answer reason: Pyelonephritis is a bacterial infection of the renal pelvis and parenchyma; urinalysis typically shows pyuria due to the presence of white blood cells in the urine. Myoglobinuria is associated with muscle injury or rhabdomyolysis, not renal infection. Ketonuria occurs with starvation or diabetic ketoacidosis. In infection, the WBC count is usually elevated rather than low.

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

Answer reason: The potassium level is critically low at 1.9 mEq/L, which indicates hypokalemia. Sodium is normal at 136, so hypernatremia is incorrect. The WBC count is normal at 6500, ruling out leukocytosis and making myelosuppression unlikely (would more typically show leukopenia and/or thrombocytopenia). Severe hypokalemia is an urgent abnormal lab due to risk for dysrhythmias and muscle weakness.

Q: What is the normal therapeutic INR for patients on warfarin?

Answer reason: For most indications treated with warfarin (e.g., atrial fibrillation, DVT/PE), the therapeutic INR target range is 2.0–3.0 to balance prevention of thrombosis with bleeding risk. An INR below this range increases risk of clot formation, while an INR substantially above it increases risk of hemorrhage. Higher targets (e.g., 2.5–3.5) may be used for certain mechanical heart valves, but that option is not provided here. Therefore, 2.0–3.0 is the best answer among the choices.

Question 1

A client is admitted with a diagnosis of hepatitis B. In reviewing the initial laboratory results, the nurse would expect to find elevation in which of the following values?

Accepted Answer

Answer reason: Hepatitis B impairs hepatic processing and excretion of bilirubin, leading to elevated serum bilirubin. BUN reflects renal function, acid phosphatase is associated with prostate/bone disease, and ESR is a nonspecific inflammation marker.

Question 2

When assessing a client admitted to the hospital for diabetic acidosis, which of the following clinical manifestations would the nurse expect?

Accepted Answer

Answer reason: Diabetic ketoacidosis causes metabolic acidosis from ketone accumulation, producing a decreased blood pH; ABG typically shows pH < 7.35 (often < 7.3) with respiratory compensation lowering PCO2.

Question 3

The nurse is caring for a 17 month-old with acetaminophen poisoning. Which of the following lab reports should the nurse review FIRST?

Accepted Answer

Answer reason: Acetaminophen overdose primarily injures the liver, causing hepatocellular necrosis. Monitoring AST/ALT first assesses the extent of hepatic damage and guides urgent management.

Question 4

The nurse is assessing a 17 year-old female client with bulimia. Which of the following laboratory reports would the nurse anticipate?

Accepted Answer

Answer reason: Bulimia often involves vomiting and laxative/diuretic misuse, causing loss of potassium and resulting hypokalemia. The other options are not characteristic expected lab findings.

Question 5

A client is diagnosed with hyperkalemia. Which EKG abnormality is most characteristic of this condition?

Accepted Answer

Answer reason: The earliest and most characteristic ECG change in hyperkalemia is tall, narrow, “tented” peaked T waves caused by accelerated repolarization of cardiac cells. Although severe hyperkalemia can progress to wide QRS complexes, peaked T waves appear first and are the most specific early indicator.

Question 6

Which electrolyte imbalance is MOST associated with flattened T waves and the presence of U waves on ECG?

Accepted Answer

Answer reason: Low potassium levels slow ventricular repolarization, leading to flattened T waves and characteristic U waves on ECG.

Question 7

Which lab value indicates hypokalemia?

Accepted Answer

Answer reason: Normal serum potassium is about 3.5–5.0 mEq/L. Hypokalemia is defined as a potassium level below 3.5 mEq/L. Therefore, 3.2 mEq/L indicates hypokalemia. By contrast, 4.2 and 3.6 mEq/L are within normal range, and 5.6 mEq/L reflects hyperkalemia.

Question 8

The nurse is aware that the following laboratory values supports a diagnosis of pyelonephritis?

Accepted Answer

Answer reason: Pyelonephritis is a bacterial infection of the renal pelvis and parenchyma; urinalysis typically shows pyuria due to the presence of white blood cells in the urine. Myoglobinuria is associated with muscle injury or rhabdomyolysis, not renal infection. Ketonuria occurs with starvation or diabetic ketoacidosis. In infection, the WBC count is usually elevated rather than low.

Question 9

A client with cancer is admitted to the oncology unit. Stat lab values reveal Hgb 12.6, WBC 6500, K+ 1.9, urea 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: The potassium level is critically low at 1.9 mEq/L, which indicates hypokalemia. Sodium is normal at 136, so hypernatremia is incorrect. The WBC count is normal at 6500, ruling out leukocytosis and making myelosuppression unlikely (would more typically show leukopenia and/or thrombocytopenia). Severe hypokalemia is an urgent abnormal lab due to risk for dysrhythmias and muscle weakness.

Question 10

What is the normal therapeutic INR for patients on warfarin?

Accepted Answer

Answer reason: For most indications treated with warfarin (e.g., atrial fibrillation, DVT/PE), the therapeutic INR target range is 2.0–3.0 to balance prevention of thrombosis with bleeding risk. An INR below this range increases risk of clot formation, while an INR substantially above it increases risk of hemorrhage. Higher targets (e.g., 2.5–3.5) may be used for certain mechanical heart valves, but that option is not provided here. Therefore, 2.0–3.0 is the best answer among the choices.

Question 11

A nurse is reviewing the laboratory results of a 60-year-old client with a pleural effusion. Which of the following laboratory findings would most likely indicate a complicated pleural effusion requiring more aggressive intervention?

Accepted Answer

Answer reason: A complicated (often parapneumonic/empyema) pleural effusion is suggested by pleural fluid acidosis and low glucose due to increased metabolic activity of bacteria and neutrophils and impaired glucose transport. A pleural fluid pH < 7.20 and glucose < 60 mg/dL are classic indicators for more aggressive management (e.g., chest tube drainage) rather than observation alone. The other options reflect normal/serum-only values or pleural fluid values more consistent with an uncomplicated effusion.

Question 12

A patient with osteomyelitis is receiving IV antibiotics. What lab value should the nurse monitor closely?

Accepted Answer

Answer reason: Osteomyelitis is a serious bone infection, and when a patient is receiving IV antibiotics, monitoring response to therapy and ongoing infection is essential. The white blood cell (WBC) count is a key marker of systemic infection and trends can help evaluate whether treatment is effective or if infection is worsening. Serum calcium, hemoglobin, and platelet count are not primary indicators of infection resolution in osteomyelitis compared with WBC trends (along with other inflammatory markers such as ESR/CRP, if available).

Question 13

A patient on levothyroxine reports feeling anxious and losing weight. What should the nurse do?

Accepted Answer

Answer reason: Anxiety and weight loss in a patient taking levothyroxine are classic symptoms of possible hyperthyroidism from over-replacement. The safest nursing action is to assess therapeutic effect and potential toxicity by checking thyroid labs (TSH with free T4, and sometimes T3) before recommending dose changes. Increasing the dose could worsen iatrogenic thyrotoxicosis, and reassurance alone ignores a potentially harmful adverse effect. Stopping the medication immediately is generally inappropriate without provider guidance unless severe toxicity is suspected, because abrupt cessation may precipitate hypothyroid symptoms and does not address dose titration.

Question 14

A client receiving chemotherapy reports bleeding gums and blood in stool. Which lab value is most concerning?

Accepted Answer

Answer reason: Bleeding gums and blood in stool in a client on chemotherapy strongly suggest thrombocytopenia-related bleeding. A platelet count of 30,000/mm3 is critically low and significantly increases risk for spontaneous bleeding and hemorrhage, requiring urgent interventions (e.g., bleeding precautions, provider notification, possible platelet transfusion depending on clinical status). The other values are not immediately dangerous in this context: Hgb 11.5 g/dL is mild anemia, WBC 5,000/mm3 is normal, and potassium 3.8 mEq/L is normal.

Question 15

A client with pneumonia is receiving IV antibiotics. Which lab value indicates the treatment is effective?

Accepted Answer

Answer reason: With effective antibiotic therapy for bacterial pneumonia, signs of systemic infection and inflammation should improve. A decreasing WBC count indicates the body’s inflammatory response is resolving and the infectious process is coming under control. In contrast, increased WBC count, elevated CRP, and increased temperature suggest ongoing or worsening infection/inflammation rather than improvement.

Question 16

A client with Cushing's syndrome has a serum potassium of 2.9 mEq/L. What should the nurse do first?

Accepted Answer

Answer reason: A potassium of 2.9 mEq/L indicates clinically significant hypokalemia, which can precipitate dangerous dysrhythmias and muscle weakness. In Cushing’s syndrome, excess cortisol has mineralocorticoid effects that promote potassium wasting, so this abnormal value requires prompt medical evaluation and treatment (e.g., potassium replacement and addressing the cause). The safest first nursing action is to notify the provider so timely orders and monitoring can be initiated. The other options are inappropriate: restricting potassium worsens hypokalemia, encouraging fluids does not correct the electrolyte deficit, and documenting/continuing care delays needed intervention.

Question 17

Which of the following lab values is expected in a patient with acute kidney injury?

Accepted Answer

Answer reason: Acute kidney injury reduces glomerular filtration and impairs renal excretion of potassium, so hyperkalemia is a common expected abnormal lab finding. In AKI, creatinine and urea (BUN) typically increase rather than decrease due to decreased clearance. Calcium is more often low or normal in AKI (hyperphosphatemia and reduced vitamin D activation contribute), making increased calcium less expected. Therefore, increased potassium is the best answer.

Question 18

When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?

Accepted Answer

Answer reason: Pallor of the skin and nail beds is a common clinical sign of anemia or reduced oxygen-carrying capacity, making hemoglobin the most direct lab to assess. A low Hgb (often along with hematocrit) correlates with decreased red blood cell mass and can explain pallor. Platelets are primarily related to bleeding/clotting risk, and WBC/neutrophils assess infection/inflammation rather than pallor.

Question 19

Which lab value is most critical in a patient with heart failure?

Accepted Answer

Answer reason: A potassium of 3.0 mEq/L indicates hypokalemia, which is clinically urgent in heart failure because it increases the risk of dangerous dysrhythmias, especially in patients on loop/thiazide diuretics and/or digoxin. Sodium 138 mEq/L is normal, BNP 90 pg/mL is not critically elevated, and hemoglobin 11.2 g/dL is mildly low but typically less immediately life-threatening than hypokalemia. Correcting potassium (and assessing magnesium) helps reduce arrhythmia risk and improves cardiac stability.

Question 20

Which of the following cerebrospinal fluid (CSF) values should be negative (absent) if the CSF is normal after a lumbar puncture?

Accepted Answer

Answer reason: Normal CSF contains glucose (not insulin) and a small amount of protein, and it may contain 0–5 WBCs/µL. Red blood cells should be absent but can appear with a traumatic tap, so “RBCs” is not the best single answer. Insulin is not a normal component of CSF and should be absent/negative, making it the best choice.

Question 21

A five year-old has been rushed to the emergency room several hours after acetaminophen poisoning. Which of the following laboratory results should receive PRIORITY attention by the nurse?

Accepted Answer

Answer reason: In suspected acetaminophen toxicity, the immediate priority is evaluating for hepatic injury and impending liver failure with a comprehensive hepatic function panel (often referred to as a chemistry/liver “profile”), which includes AST/ALT (often rise early), bilirubin, and other markers. Bilirubin may be elevated later and is not as sensitive early as transaminases, while ESR and neutrophils are nonspecific for acetaminophen toxicity. Therefore, the best priority choice among the options is the broader liver profile.

Question 22

As a part of a 9 pound newborn's assessment, the nurse performs a dextro-stick at one hour. The blood glucose level is 45 mg/dL. What FIRST action by the nurse is appropriate?

Accepted Answer

Answer reason: Newborns are at risk for hypoglycemia, and a glucose of 45 mg/dL at 1 hour is borderline/low; the appropriate first action is to feed (breastfeed or formula) to raise glucose and prevent neurologic injury. Waiting 2 hours to repeat without intervention can delay treatment if the level drops further. Notifying the provider is not the first step if the infant can be fed promptly, and checking other labs does not address the immediate low glucose.

Question 23

The nurse is caring for a 4 year-old admitted after receiving burns to more than 50% of his body. Which laboratory data should be reviewed by the nurse as a PRIORITY in the first 24 hours?

Accepted Answer

Answer reason: In the first 24 hours after major burns, massive fluid shifts and capillary leak cause hemoconcentration; hematocrit helps evaluate hypovolemia and adequacy of fluid resuscitation. While renal labs (BUN) can become abnormal with poor perfusion, urine output and hemodynamic status guide early resuscitation and hematocrit is a key early indicator of hemoconcentration. Blood glucose and WBC are less immediate indicators of early burn shock management.

Question 24

Which EKG change indicates life-threatening worsening hyperkalemia?

Accepted Answer

Answer reason: Hyperkalemia progresses from peaked T waves to conduction slowing, including PR prolongation, loss of P waves, widening of the QRS, and ultimately a sine-wave pattern and ventricular standstill. ST depression is not characteristic of hyperkalemia, and U waves are associated with hypokalemia. PR prolongation reflects worsening conduction abnormalities and increasing risk of life-threatening dysrhythmias.

Question 25

Fasting blood sugar in normal individuals is?

Accepted Answer

Answer reason: Normal fasting plasma glucose is about 70–99 mg/dL (mg/100 mL). The option 80–100 mg/100 mL best matches the accepted normal range. Values starting at 100 mg/dL and higher may indicate impaired fasting glucose or diabetes depending on the level and repeat testing.

Question 26

The nurse cares for a patient with prolonged and intractable vomiting. Which lab result does the nurse associate with a complication of this condition?

Accepted Answer

Answer reason: Prolonged vomiting causes loss of gastric hydrochloric acid (H+ and chloride), leading to metabolic alkalosis, which presents with an increased blood pH. The expected compensatory response would be hypoventilation with an increased PaCO2 (not decreased). Vomiting also commonly leads to hypokalemia rather than elevated potassium, and sodium changes are variable depending on fluid replacement and volume status.

Question 27

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

Accepted Answer

Answer reason: Autoimmune thrombocytopenic purpura (ITP) is characterized by immune-mediated platelet destruction, so the key indicator of treatment response is a rising platelet count. Monitoring platelet trends helps evaluate bleeding risk and effectiveness of therapies such as corticosteroids, IVIG, or splenectomy. WBC count and potassium do not reflect ITP response. PTT assesses intrinsic coagulation factor activity and is typically normal in isolated thrombocytopenia, so it is not the best marker of response.

Question 28

Which lab value is abnormal?

Accepted Answer

Answer reason: Normal sodium is approximately 135–145 mEq/L, so a sodium of 115 mEq/L is markedly low and indicates severe hyponatremia. This level can cause neurologic symptoms such as headache, confusion, seizures, and can be life-threatening due to cerebral edema. The other values listed are within typical reference ranges: potassium ~3.5–5.0, calcium ~8.6–10.2 mg/dL, and magnesium ~1.7–2.2 mg/dL. Therefore, sodium 115 mEq/L is the abnormal value.

Question 29

The nurse reviews a client’s lab report and notes that their serum phosphorus level is 1.8 mg/dL. Which condition most likely caused this?

Accepted Answer

Answer reason: A serum phosphorus of 1.8 mg/dL indicates hypophosphatemia. Malnutrition (and associated poor intake/refeeding risk) is a common cause due to depleted total body phosphate stores and shifts into cells when nutrition is restarted. In contrast, renal insufficiency, hypoparathyroidism, and tumor lysis syndrome more typically cause hyperphosphatemia because phosphate is retained or released from cells.

Question 30

Lab Values NCLEX Question The patient has a sodium level of 125 mEq/L (Normal: 136-145 mEq/L) Which data collected by the practical nurse supports the health care provider’s diagnosis of hyponatremia related to fluid overload?

Accepted Answer

Answer reason: Hyponatremia related to fluid overload is typically dilutional and occurs with excess total body water, producing signs of hypervolemia. Bilateral +3 ankle edema directly supports fluid overload due to increased hydrostatic pressure and interstitial fluid accumulation. The other options (weak/thready pulse, hypotension, lightheadedness) more strongly suggest hypovolemia or decreased perfusion rather than fluid excess. Therefore, significant dependent edema best supports the provider’s diagnosis.

Question 31

A nurse is caring for a client prescribed lisinopril. Which of the following findings should the nurse report to the healthcare provider immediately?

Accepted Answer

Answer reason:  Serum potassium of 5.8 mEq/L Lisinopril (an ACE inhibitor) can cause hyperkalemia by reducing aldosterone-mediated potassium excretion. A potassium level of 5.8 mEq/L is clinically significant and increases the risk of dangerous dysrhythmias, so it requires immediate provider notification and likely intervention. Dry cough is a common adverse effect but is typically non-emergent unless airway compromise is suspected. The listed blood pressure and heart rate are within acceptable ranges and do not require urgent reporting.

Question 32

The nurse is admitting a patient with a history of lung disease who is at risk for developing respiratory acidosis. The nurse should assess the patient for which sign of respiratory acidosis?

Accepted Answer

Answer reason:  Respiratory acidosis is typically caused by hypoventilation with CO2 retention, which can produce CNS effects such as headache, confusion, and restlessness. Dyspnea can be present as the patient senses inadequate ventilation, and cardiac dysrhythmias can occur, but the prompt indicates a select-all-that-apply format where multiple findings may be correct. Because multiple listed options are consistent with respiratory acidosis, a single best answer cannot be selected without violating the SATA requirement.

Question 33

Which lab result requires immediate follow-up by the nurse?

Accepted Answer

Answer reason:  Potassium 2.8 mEq/L A potassium of 2.8 mEq/L is significant hypokalemia, which can precipitate dangerous cardiac dysrhythmias and requires prompt assessment and intervention (e.g., ECG monitoring and potassium replacement per orders). The other values are not as immediately life-threatening: sodium 135 mEq/L is within normal range, hemoglobin 13.5 g/dL is normal, and WBC 12,000/mm3 is only mildly elevated and typically does not require emergent action without other clinical findings. Therefore, the potassium result is the priority for immediate follow-up.

Question 34

A nurse is caring for a client with hypokalemia as a result of long-term steroid therapy. Based on this diagnosis, which of the following signs or symptoms would the nurse expect to see?

Accepted Answer

Answer reason:  Fatigue and muscle weakness Hypokalemia commonly causes skeletal muscle weakness, fatigue, cramps, and in more severe cases can lead to paralysis and dysrhythmias due to impaired neuromuscular excitability. Long-term corticosteroid therapy can promote renal potassium wasting (mineralocorticoid effect), increasing risk for hypokalemia symptoms. Diarrhea is more associated with potassium loss causing hypokalemia but the symptom pairing here (nausea and diarrhea) is not the classic expected presentation compared with weakness. Hypoglycemia is inconsistent because steroids more typically raise blood glucose, and hypertension is a steroid effect but not a key symptom of hypokalemia itself.

Question 35

A client taking lithium has a lithium level of 2.6 mEq/L (2.6 mmol/L). The client is also reporting vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. How does the nurse interpret the client's lithium level?

Accepted Answer

Answer reason:  A lithium level of 2.6 mEq/L is above the typical therapeutic range (about 0.6–1.2 mEq/L for maintenance; toxicity often occurs at >1.5 mEq/L). The client’s GI symptoms (vomiting, diarrhea, abdominal pain) and neurologic findings (tremor, blurred vision, tinnitus) are consistent with lithium toxicity. This level requires prompt nursing action (hold lithium, assess hydration/renal function, and notify the provider) to prevent progression to severe neurotoxicity.

Question 36

Which lab value is most critical to monitor in a patient on warfarin therapy?

Accepted Answer

Answer reason:  A. INR Warfarin’s anticoagulant effect is monitored using the INR (derived from the prothrombin time), and dosing is adjusted to keep the INR within a therapeutic range to prevent bleeding or clotting. Electrolytes like sodium and potassium are not direct measures of warfarin activity. Hemoglobin can indicate bleeding but is not the primary lab used to titrate or monitor warfarin therapy effectiveness and safety.

Question 37

The nurse reviews the arterial blood gas results of a client; pH 7.43, PCO2 30 mm Hg, and HCO3- 24 mEq/L (24 mmol/L). The nurse recognizes this as which condition?

Accepted Answer

Answer reason: Respiratory alkalosis, compensated. The pH is slightly alkalemic/high-normal (7.43) and the PaCO2 is low (30 mm Hg), indicating a primary respiratory alkalosis. The HCO3- is normal (24 mEq/L), which would suggest little to no metabolic compensation; however, among the provided options, the only choice matching the primary disturbance (low PaCO2 with alkalemia) is respiratory alkalosis. The other options do not fit because respiratory acidosis would have elevated PaCO2, and metabolic disorders would require an abnormal HCO3- as the primary change.

Question 38

A client with acute kidney injury (AKI) has serum potassium of 6.2 mEq/L. Which prescription from the primary healthcare provider should the nurse perform first?

Accepted Answer

Answer reason: Place the client on a cardiac monitor A potassium of 6.2 mEq/L indicates hyperkalemia, which can rapidly cause life-threatening cardiac dysrhythmias. The immediate nursing priority is to detect rhythm changes early and enable rapid intervention, so continuous cardiac monitoring is performed first. Treatments like insulin with glucose and sodium polystyrene sulfonate lower potassium, but monitoring addresses the most immediate safety threat while those therapies are prepared/initiated. Dietary restriction is a longer-term measure and is not the first action in an acute situation.

Question 39

A nurse is administering furosemide to a client with congestive heart failure. Which of the following lab results is most important to monitor?

Accepted Answer

Answer reason: Furosemide is a loop diuretic that increases urinary excretion of potassium, placing the client at high risk for hypokalemia. Low potassium can precipitate dangerous cardiac dysrhythmias, which is especially concerning in congestive heart failure. Monitoring potassium guides timely replacement and helps prevent complications such as arrhythmias and muscle weakness.

Question 40

The nurse reviews the arterial blood gas results of a client and notes that the results indicate a pH of 7.30, Pco2 of 52 mm Hg, and HCO3- of 22 mEq/L. Which interpretation does the nurse correctly make about these results?

Accepted Answer

Answer reason: Respiratory acidosis. The pH is low (7.30), indicating acidemia. The PaCO2 is elevated (52 mm Hg), which is the primary driver of the acidosis, consistent with respiratory acidosis from hypoventilation/CO2 retention. The HCO3- is 22 mEq/L (near normal), suggesting little to no metabolic compensation yet, supporting an acute or minimally compensated respiratory acidosis.

Question 41

The nurse just received the client's morning laboratory results. Which of these results is of most concern?

Accepted Answer

Answer reason: Serum magnesium level of 0.8 mEq/L This value indicates significant hypomagnesemia, which can precipitate dangerous ventricular dysrhythmias (including torsades de pointes) and increases neuromuscular excitability. Magnesium depletion also worsens or sustains hypokalemia and hypocalcemia, making cardiac instability harder to correct unless magnesium is addressed. In comparison, sodium of 134 mEq/L is mild hyponatremia, potassium of 5.2 mEq/L is mild hyperkalemia, and calcium of 10.6 mg/dL is only slightly elevated—typically less immediately life-threatening than severe low magnesium.

Question 42

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL; serum magnesium, 1.0 mEq/L; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity?

Accepted Answer

Answer reason: Hypomagnesemia increases myocardial sensitivity to digoxin and predisposes the client to dysrhythmias, raising toxicity risk even when the digoxin dose is unchanged. The magnesium level given (1.0 mEq/L) is low, making this the key abnormality. The potassium (4.1 mEq/L) and creatinine (0.9 mg/dL) are within expected ranges here, and the calcium (9.8 mg/dL) is not elevated.

Question 43

A client with Addison’s disease is receiving IV glucocorticoids. What intervention is most important?

Accepted Answer

Answer reason: Addison’s disease involves mineralocorticoid deficiency, predisposing the client to hyponatremia and hyperkalemia; during acute illness and treatment, these electrolyte shifts can become rapidly life-threatening (e.g., dysrhythmias, hypotension). Even when IV glucocorticoids are given, ongoing adrenal-related electrolyte instability can persist and must be tracked closely to guide fluid and electrolyte replacement. Monitoring sodium and potassium is therefore the highest-priority safety intervention to detect and prevent complications early.

Question 44

A client with Addison's disease is receiving IV Solu-Medrol (methylprednisolone). What is the primary nursing action?

Accepted Answer

Answer reason: Glucocorticoid therapy in a client with adrenal insufficiency can significantly affect fluid and electrolyte balance, including risks related to sodium retention, potassium shifts, and overall volume status. Addison’s disease is associated with baseline electrolyte instability, and IV steroid replacement can rapidly change these values, so lab monitoring is the most immediate safety-focused action. Early detection of electrolyte derangements helps prevent dysrhythmias, hypotension, and other acute complications. The other options may be relevant ongoing assessments, but they are not as primary or broadly safety-critical as trending electrolytes in this setting.

Question 45

An ABG is ordered for your patient with COPD. The following results come back. pH 7.25, CO2 50, HCO3 24. How do you interpret these results?

Accepted Answer

Answer reason: The pH is low (7.25), indicating acidemia. The PaCO2 is elevated (50 mmHg), which is an acidifying respiratory component and matches the direction of the pH change. The HCO3 (24) is within normal limits, indicating there is no meaningful metabolic compensation yet, consistent with an acute/uncompensated respiratory acid-base disorder often seen with hypoventilation in COPD exacerbations.

Question 46

A client with diabetes mellitus has a glycosylated hemoglobin A1c level of 8%. On the basis of this test result, the nurse plans to teach the client about the need for which measure?

Accepted Answer

Answer reason: An A1c of 8% indicates that average blood glucose has been above target over the prior ~2–3 months, reflecting overall suboptimal glycemic control. Teaching should therefore focus on strategies to prevent sustained elevations and on recognizing symptoms/signs of elevated glucose so the client can intervene early. This includes reinforcing self-monitoring, medication adherence, diet/activity planning, and when to contact the provider for persistent high readings. While infection prevention and hypoglycemia education are important in diabetes care, this lab value most directly signals the need to address chronic hyperglycemia.

Question 47

Following a thyroidectomy, a patient develops tingling around the mouth and muscle cramps. Which action should the nurse take first?

Accepted Answer

Answer reason: Tingling around the mouth and muscle cramps after thyroidectomy are classic early signs of hypocalcemia from transient or inadvertent parathyroid injury, which can progress to tetany and laryngospasm. The priority initial nursing action is to assess/confirm the suspected electrolyte abnormality by obtaining/monitoring calcium so treatment can be rapidly initiated. Reassurance delays evaluation, and oxygen does not address the underlying cause. After confirming/recognizing likely hypocalcemia, the provider should be notified and IV calcium prepared per protocol.

Question 48

During the endorsement(or change of shift), the nurse mentioned that the pH level of the newly admitted client is 7.30. The incoming nurse checked the client's history and found out that the client has acute renal failure. Which of the following signs and symptoms will the nurse assess based on the laboratory result?

Accepted Answer

Answer reason:  A pH of 7.30 indicates acidemia, and acute renal failure commonly causes metabolic acidosis due to impaired hydrogen ion excretion and reduced bicarbonate regeneration. The expected compensatory response is increased respiratory rate and depth (Kussmaul-type breathing) to blow off CO2 and raise pH. The other options are not the hallmark compensatory finding for metabolic acidosis in renal failure.

Question 49

A client came in to the hospital due to sepsis. Laboratory result shows BUN of 50 mg/dl, serum creatinine of 2.0 mg/dl, urine sodium of 70 mEq/L, urine specific gravity of 1.010, and cellular casts and debris in the urine. The nurse knows based on the laboratory results that the client is having?

Accepted Answer

Answer reason: The findings are consistent with acute tubular necrosis from sepsis-related ischemia/toxin-mediated tubular injury. A high urine sodium (70 mEq/L) and isosthenuria (specific gravity ~1.010) indicate impaired tubular reabsorption and concentrating ability, which points away from prerenal azotemia. Cellular casts and debris further support intrinsic kidney damage rather than obstruction. Postrenal causes are less likely without signs of outflow blockage and typically do not primarily present with tubular casts.

Question 50

The nurse is reviewing a client's record and notes that the health care provider has documented that the client has a renal function disorder. On review of the laboratory results, the nurse most likely would expect to note which finding?

Accepted Answer

Answer reason: Impaired renal function reduces glomerular filtration, leading to accumulation of nitrogenous waste products, most notably creatinine, in the blood. Serum creatinine is therefore a direct and common indicator of decreased kidney clearance. While anemia (low hemoglobin/RBC) can occur in chronic kidney disease due to reduced erythropoietin production, it is less immediate and less specific than an elevated creatinine for detecting renal dysfunction. A decreased white blood cell count is not a typical expected finding of renal impairment.

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