Question 1

After 7 days of iron therapy, the child with iron- deficiency anemia has serum laboratory tests completed. Which finding indicates that the iron therapy is beginning to correct the anemia?

Accepted Answer

Answer reason: A rising reticulocyte count reflects increased RBC production before hemoglobin and hematocrit show substantial improvement. Granulocyte changes relate to white blood cell production and are not a marker of anemia correction. Indirect bilirubin would more strongly suggest increased hemolysis rather than recovery, and erythropoietin typically increases in anemia/hypoxia but should not be used as the key lab sign that iron therapy is successfully restoring RBC production.

Question 2

The nurse reviews the assessment of a client with acute respiratory distress syndrome (ARDS). What is the best indicator of improvement in the client?

Accepted Answer

Answer reason: ABG trends (especially PaO2, PaCO2, and pH, often interpreted alongside oxygen requirements) directly reflect whether ventilation/oxygenation is improving. Bronchoscopy findings and sputum culture results may help identify etiology but do not measure physiologic recovery of gas exchange. Blood pressure can change for many unrelated reasons (fluids, sedation, sepsis) and is not a specific marker of ARDS improvement.

Question 3

The nurse is analyzing serum laboratory results for a 73-year-old female scheduled for surgery in 2 hours. Which result should the nurse inform the surgeon about immediately?

Accepted Answer

Answer reason: A markedly prolonged PT indicates impaired coagulation (e.g., anticoagulant effect, liver dysfunction, vitamin K deficiency) and raises the chance of excessive surgical bleeding, so the surgeon/anesthesia team must be notified promptly for possible delay or reversal. The other values are not urgent for imminent surgery: potassium is normal, creatinine is normal, and hemoglobin of 10 g/dL is mild anemia that is often tolerated depending on procedure and comorbidities. Because surgery is in 2 hours, an abnormal coagulation result is the most time-critical finding to escalate.

Question 4

The nurse working in the emergency department is caring for a client with suspected acute myocardial infarction. STAT blood tests are ordered. Which test result should the nurse be most concerned?

Accepted Answer

Answer reason: In suspected acute myocardial infarction, the most urgent lab concern is evidence of myocardial cell injury, reflected by elevated cardiac enzymes. CK-MB is relatively specific to cardiac muscle, and an increased fraction suggests myocardial necrosis and supports the suspected diagnosis, prompting rapid escalation of cardiac protocols and monitoring for complications (dysrhythmias, heart failure). The other values listed are within typical reference ranges or are nonspecific for acute MI (hematocrit normal, ESR not an acute MI marker, mild glucose elevation is not the primary emergency signal). Therefore, this result is the one most concerning in the context of suspected MI.

Question 5

A client starts filgrastim (Neupogen) injections 11 days after completing a course of chemotherapy. Which lab value indicates the neupogen is effective?

Accepted Answer

Answer reason: Filgrastim is a granulocyte colony-stimulating factor that increases neutrophil production to reduce chemotherapy-associated neutropenia and infection risk. Effectiveness is best reflected by improvement in absolute neutrophil count (ANC), with values rising above the severe neutropenia range (

Question 6

The nurse is admitting a client with newly diagnosed Cushing’s syndrome. Which of the following serum laboratory results might be expected for this client?

Accepted Answer

Answer reason: Excess cortisol has mineralocorticoid effects that promote sodium retention and expanded extracellular volume, making increased sodium a plausible finding. Cortisol also increases gluconeogenesis and causes insulin resistance, so many clients show hyperglycemia, which makes options suggesting decreased glucose inconsistent with the condition. Options with decreased cortisol contradict the defining physiology of Cushing’s syndrome, and decreased sodium is more characteristic of adrenal insufficiency than cortisol excess.

Question 7

A client with renal insufficiency is admitted with a diagnosis of pneumonia. He’s being treated with I.V. antibiotics, which can be nephrotoxic. Which laboratory value(s) should be monitored closely?

Accepted Answer

Answer reason: V. antibiotics can worsen kidney function, so the priority is monitoring objective markers of renal filtration. Rising serum creatinine and BUN indicate declining glomerular filtration and developing or worsening acute kidney injury on top of renal insufficiency. These labs are also used clinically to guide renal dosing adjustments and to determine whether the offending agent should be reduced or stopped. ABGs primarily evaluate respiratory status, and platelet count is not a primary indicator of nephrotoxicity; potassium can become abnormal with renal failure but is downstream and less specific than direct kidney function markers.

Question 8

The nurse is analyzing the serum laboratory report for the client diagnosed with lung cancer that has metastasized to the pelvic bone. Which specific finding should the nurse anticipate?

Accepted Answer

Answer reason: Lung cancers can also produce humoral hypercalcemia (e.g., PTHrP), further raising serum calcium even without extensive bone destruction. The other options are less specific to bone metastasis: anemia can occur but is not a hallmark lab finding of isolated pelvic bone metastasis, elevated creatinine reflects renal dysfunction, and CK rises with skeletal muscle injury rather than bony metastatic disease. Anticipating hypercalcemia supports early monitoring for dehydration, constipation, confusion, and dysrhythmias.

Question 9

The nurse is caring for the client who has limited intake due to dysphagia following an ischemic stroke. Which serum laboratory result should the nurse review to verify that the client is dehydrated?

Accepted Answer

Answer reason: This typically raises BUN (often with an increased BUN-to-creatinine ratio) and is a common lab clue of hypovolemia from poor oral intake. Creatinine may be normal early or rise later, making it less sensitive for mild dehydration compared with BUN. Decreased hemoglobin is not expected with dehydration (hemoconcentration tends to increase it), and decreased prealbumin indicates poor protein intake/malnutrition rather than acute volume depletion.

Question 10

The nurse is reviewing laboratory results for the child with Kawasaki disease. Which result requires the nurse’s immediate notification of the HCP?

Accepted Answer

Answer reason: A platelet count in this range is substantially elevated and warrants prompt provider notification to ensure appropriate antiplatelet management and monitoring for cardiac complications. The other findings listed (mild leukocytosis, elevated ESR, and mildly elevated liver enzymes) are expected inflammatory/liver-related abnormalities in Kawasaki disease and are typically not as immediately actionable for acute complication prevention. Immediate communication helps reduce risk of preventable clot-related events while therapy and follow-up are adjusted.

Question 11

The nurse is reviewing the laboratory results for the infant newly diagnosed with hemophilia A. Which finding should the nurse expect?

Accepted Answer

Answer reason: The aPTT assesses the intrinsic and common pathways, so it becomes prolonged when factor VIII is low. PT primarily reflects the extrinsic pathway (factor VII) and is typically normal in hemophilia A, making that distractor inconsistent. Hemoglobin and hematocrit are not expected to be decreased unless there is significant ongoing bleeding; the hallmark screening abnormality is the intrinsic-pathway prolongation.

Question 12

The nurse reviews a client’s arterial blood gas results. The results are as follows: pH is 7.6, PaCO2 is 37 mm Hg, and HCO3 is 32 mEq/L. Which acid-base imbalance is this client experiencing?

Accepted Answer

Answer reason: A pH of 7.6 indicates alkalemia. The PaCO2 is within the expected range (35–45 mm Hg), so a primary respiratory cause is not supported. The HCO3 is elevated (normal ~22–26 mEq/L), which indicates a primary metabolic process driving the alkalemia. In respiratory alkalosis, the expected primary change would be a low PaCO2 rather than an elevated bicarbonate.

Question 13

The nurse is reviewing the laboratory results from a female diabetic client admitted to the acute care facility with dehydration. Which laboratory result is consistent with a diagnosis of dehydration?

Accepted Answer

Answer reason: Urine dipstick specific gravity of 1.035 Dehydration causes hemoconcentration and the kidneys conserve water, producing smaller volumes of more concentrated urine. A urine specific gravity of 1.035 is elevated and reflects concentrated urine consistent with fluid volume deficit. The other values listed are not supportive of dehydration: hematocrit of 40% is within typical adult female range, creatinine of 0.8 mg/dL is normal, and HbA1c reflects longer-term glycemic control rather than acute hydration status. In a dehydrated diabetic client, concentrated urine is a key lab indicator of reduced intravascular volume and renal water conservation.

Question 14

A client received a kidney transplant 2 months ago. He's admitted to the hospital with the diagnosis of acute rejection. Which assessment finding should the nurse anticipate?

Accepted Answer

Answer reason: As glomerular filtration rate falls, nitrogenous wastes are retained, so BUN and creatinine rise and are key early indicators of graft dysfunction. Fever and graft tenderness can occur, making a normal temperature less consistent with acute rejection. Decreased WBC counts more strongly suggests immunosuppression effects rather than a rejection episode, and hypotension is not a typical primary finding of rejection unless another complication is present.

Question 15

Laboratory tests are prescribed for the client who has a smooth and reddened tongue and ulcers at the corners of the mouth. Which result would the nurse find if the client has iron-deficiency anemia?

Accepted Answer

Answer reason: The described findings (glossitis and angular cheilitis) are classic mucosal signs associated with iron deficiency from epithelial atrophy. Elevated RBC count would be inconsistent because iron deficiency typically lowers RBC production and produces microcytic, hypochromic cells. Prolonged PT suggests a coagulation factor problem (e.g., vitamin K deficiency/liver disease), and elevated WBCs indicate infection/inflammation rather than iron-deficiency anemia.

Question 16

The nurse is reviewing laboratory values of a client recently diagnosed with chronic lymphocytic leukemia. The nurse would anticipate the results to include which of the following?

Accepted Answer

Answer reason: Progressive marrow infiltration can suppress normal hematopoiesis, leading to cytopenias such as thrombocytopenia. Granulocyte proliferation points instead toward myeloid leukemias (e.g., CML), not CLL. ESR or liver transaminase elevations are nonspecific and are not the hallmark laboratory pattern anticipated with this diagnosis.

Question 17

The nurse reviews arterial blood gas results for his client with chronic obstructive pulmonary disease (COPD). The pH is 7.3, PaCO2 is 56 mm Hg, and HCO3 is 24 mEq/L. Which acid–base imbalance is this client experiencing?

Accepted Answer

Answer reason: A primary acid–base disorder is identified by the direction of pH change and which value (PaCO2 or HCO3−) is driving it. The pH of 7.3 indicates acidemia, and the PaCO2 is elevated at 56 mm Hg, showing CO2 retention from hypoventilation, which is the hallmark of a primary respiratory acidosis. The bicarbonate is 24 mEq/L (normal), indicating little to no metabolic compensation yet. In COPD, impaired ventilation commonly leads to hypercapnia and thus a respiratory (not metabolic) acidosis.

Question 18

To detect fetal distress during labor, a nurse should be alert for which finding?

Accepted Answer

Answer reason: Fetal scalp pH of 7.14 A low fetal scalp pH indicates fetal acidemia from inadequate oxygenation and is a direct, objective marker of fetal compromise during labor. Values below about 7.20 are concerning, and a value of 7.14 strongly suggests significant hypoxia requiring prompt evaluation and likely intrauterine resuscitation and/or expedited delivery. A baseline fetal heart rate around 110–160 is normal, so 144 bpm alone is not distress. Accelerations and the presence of moderate/long-term variability are reassuring signs of intact fetal neurologic function and adequate oxygenation, not distress.

Question 19

The nurse is caring for a client who was admitted with a diagnosis of diabetic ketoacidosis (DKA). The nurse is aware of possible complications related to fluid and electrolyte imbalances. Which of the following laboratory tests would be the priority to monitor as the client receives initial treatment of insulin and I.V. fluids?

Accepted Answer

Answer reason: In DKA, total-body potassium is depleted from osmotic diuresis even when the initial serum value may be normal or elevated, so replacement decisions depend on frequent monitoring. IV fluid resuscitation also improves renal perfusion and can further change potassium dynamics, making early trends clinically critical. A1C reflects long-term glycemic control rather than acute stability, while calcium and “serum nitrogen” (BUN) may be monitored but are not as immediately dangerous as potassium shifts during initial DKA treatment.

Question 20

A client with a history of chronic renal failure is admitted to the unit with pulmonary edema after missing his dialysis treatment yesterday. His laboratory result levels are serum potassium 6.0 mEq/L, serum sodium 130 mEq/L, and serum bicarbonate 18 mEq/L. The nurse interprets that the client has which of the following conditions?

Accepted Answer

Answer reason: A potassium level of 6.0 mEq/L is above the usual upper limit (~5.0 mEq/L), consistent with impaired renal excretion after missed dialysis. The sodium of 130 mEq/L indicates hyponatremia (so hypernatremia is incorrect), and bicarbonate of 18 mEq/L suggests metabolic acidosis rather than alkalemia. In chronic renal failure, missed dialysis commonly leads to potassium retention, creating high risk for dysrhythmias and necessitating prompt recognition.

Question 21

After cardiac surgery, a client’s blood pressure measures 126/80 mm Hg. The nurse determines that mean arterial pressure (MAP) is?

Accepted Answer

Answer reason: MAP estimates average arterial perfusion pressure and is calculated as DBP + 1/3(SBP−DBP) because diastole lasts longer than systole. With 126/80, the pulse pressure is 46, one-third is about 15.3, and adding to the diastolic pressure yields about 95.3 mm Hg (rounded to 95). This value is clinically relevant post-cardiac surgery because MAP is used to judge adequacy of organ perfusion and guide hemodynamic management. Options near the diastolic pressure alone (e.g., 80) underestimate true average perfusion pressure.

Question 22

The nurse is reviewing a client’s laboratory values and recognizes that the lab changes most consistent with a diagnosis of aplastic anemia would be?

Accepted Answer

Answer reason: This produces low RBCs (anemia), low WBCs (infection risk), and low platelets (bleeding risk) on CBC. Isolated T-helper cell changes point more toward immune disorders rather than global marrow suppression. Reed-Sternberg cells with lymphadenopathy is characteristic of Hodgkin lymphoma, not aplastic anemia.

Question 23

The progress notes of the postoperative client who has a wound infection state that the client has a shift to the left in the WBC differential count. Which finding by the nurse reviewing the client's laboratory report would support the HCP's documentation?

Accepted Answer

Answer reason: Band neutrophils are the classic immature form counted on the differential, so an elevated band count directly supports the documentation of a left shift in a postoperative wound infection. A decreased total WBC does not define a left shift and may occur in severe infection but would not specifically confirm the differential pattern. Elevated C-reactive protein reflects inflammation but is nonspecific and does not indicate the presence of immature neutrophils on the differential.

Question 24

The nurse is reviewing lab results of a newly admitted client. Which group of laboratory results, along with the clinical manifestations, establishes a diagnosis of Reye’s syndrome?

Accepted Answer

Answer reason: Elevated transaminases support acute liver injury, while prolonged PT and PTT indicate reduced production of vitamin K–dependent and other coagulation factors from hepatic failure. This constellation aligns with the expected life-threatening pattern of hepatic dysfunction seen in Reye’s and helps establish the diagnosis when paired with neurologic findings after a viral illness/aspirin exposure. A common distractor is isolated cholestatic markers (bilirubin/alkaline phosphatase), which suggest biliary obstruction rather than acute hepatic failure.

Question 25

A client with heart failure is given furosemide (Lasix) 40 mg I.V. daily. The morning serum potassium level is 2.8 mEq/L. Which nursing action is the most appropriate?

Accepted Answer

Answer reason: A potassium of 2.8 mEq/L is clinically significant hypokalemia and increases risk for dangerous dysrhythmias, especially in a heart failure patient who may be on other cardioactive drugs. Loop diuretics promote potassium loss, so the safest action is to hold further potassium-wasting therapy until the low value is verified and treated. The nurse should promptly communicate the critical result, confirm it per protocol/order, and obtain orders for potassium replacement and/or adjustment of diuretic therapy with ECG monitoring as indicated. Changing the dose independently is outside nursing scope, and sodium polystyrene sulfonate is used for hyperkalemia, making it unsafe here.

Question 26

The nurse is assessing recent Hgb A,C values for the 12-year-old client. The most recent value is 8.9%, and the last three blood glucose results for the past 24 hours are 110 mg/dL, 138 mg/dL, and 130 mg/dL. What is the nurse’s best interpretation of these values?

Accepted Answer

Answer reason: HbA1c reflects average glycemic control over roughly the prior 2–3 months, so a value of 8.9% indicates overall hyperglycemia and suboptimal long-term management. In contrast, the fingerstick glucose values over the last 24 hours (110–138 mg/dL) are near goal for many pediatric regimens and suggest recent improvement. This pattern most strongly fits historically poor control with short-term better readings, rather than consistently good control. The stress explanation is incorrect because stress tends to raise true glucose values and does not create “false high” capillary results in this context.

Question 27

The hospitalized child with severe asthma has ABGs of pH = 7.30, Paco2 = 49 mm Hg, and HCO3 = 24 mEq/L. Which signs and symptoms noted during the assessment should the nurse associate with these results?

Accepted Answer

Answer reason: Hypercapnia causes sympathetic stimulation and cerebral vasodilation, producing headache, diaphoresis, tachycardia, flushing, and anxiety/restlessness. As CO2 rises further, neurologic effects such as confusion can appear. Options describing paresthesias/twitching from alkalosis or fruity breath odor from ketoacidosis do not match this acid–base pattern.

Question 28

The nurse is reviewing the lab results of a patient taking warfarin for atrial fibrillation. Which of the following international normalized ratio (INR) values would the nurse consider therapeutic for this patient?

Accepted Answer

Answer reason: 2.4 Therapeutic anticoagulation with warfarin for nonvalvular atrial fibrillation is generally targeted to an INR of 2.0–3.0 to reduce thromboembolic stroke risk while limiting bleeding risk. A value of 2.4 falls within this goal range and indicates appropriate anticoagulant effect. An INR below 2.0 (e.g., 0.8 or 1.8) suggests under-anticoagulation with inadequate stroke prevention. An INR above 3.0 (e.g., 3.1) increases bleeding risk and typically prompts closer monitoring and possible dose adjustment depending on clinical context.

Question 29

The nurse is assessing a client with suspected acute cholecystitis. Which of the following findings would support a diagnosis of acute cholecystitis?

Accepted Answer

Answer reason: Leukocytosis is a classic supporting lab finding along with fever and right upper quadrant pain, reflecting the body’s response to infection/inflammation. In contrast, decreased bilirubin and decreased aminotransferases would not be expected; if biliary obstruction extends to the common bile duct, bilirubin and liver enzymes are more likely to increase rather than decrease. HDL-C changes are not a diagnostic feature of acute gallbladder inflammation.

Question 30

A client had extensive, prolonged surgery. Which electrolyte level should the nurse monitor most closely?

Accepted Answer

Answer reason: Even modest potassium abnormalities can quickly cause dangerous cardiac dysrhythmias and skeletal muscle weakness, making it a high-priority electrolyte to trend closely postoperatively. GI losses (e.g., suctioning, vomiting) and renal perfusion changes can further precipitate hypokalemia. Compared with sodium, chloride, or calcium, potassium is most immediately life-threatening when deranged because of its direct effect on myocardial conduction and excitability.

Question 31

A nurse is caring for a client who has heart failure and is prescribed furosemide (Lasix). Which of the following findings should the nurse report to the provider immediately?

Accepted Answer

Answer reason: Serum potassium level of 2.9 mEq/L Loop diuretics increase renal excretion of potassium, placing clients at risk for clinically significant hypokalemia. A potassium of 2.9 mEq/L is dangerously low and can precipitate ventricular dysrhythmias, worsen digoxin toxicity risk (if applicable), and cause muscle weakness. This abnormal value requires prompt provider notification and likely potassium replacement and/or medication adjustment. By contrast, a modest BP of 108/70 can be acceptable if asymptomatic, and mild edema/expected weight loss may reflect therapeutic diuresis rather than an urgent adverse effect.

Question 32

The nurse is preparing to administer the fourth dose of vancomycin IVPB to a client with infective endocarditis. Which intervention does the nurse anticipate?

Accepted Answer

Answer reason: Vancomycin dosing is commonly guided by serum levels, and the trough (or pre-dose level) is obtained immediately before the next scheduled dose to reflect the lowest concentration and guide dose/interval adjustments. By the fourth dose, steady-state is likely approaching, making this an appropriate time to assess levels in many protocols. Infusing too rapidly risks infusion-related reactions (e.g., flushing/hypotension), but the key anticipated intervention tied to a scheduled dose in this context is obtaining the pre-dose level rather than routine antiemetics or replacing the IV site.

Question 33

The nurse is caring for a client diagnosed with multiple myeloma. The nurse reviews the client's lab values and notes a serum calcium level of 14 mg/dL [9-10.5 mg/dL]. What is the priority action the nurse should take?

Accepted Answer

Answer reason: In multiple myeloma, hypercalcemia commonly reflects bone breakdown and requires prompt medical treatment (e.g., IV fluids, calcitonin, bisphosphonates) rather than routine observation. The nurse should escalate immediately so orders and rapid interventions can be initiated and complications prevented. Simply documenting or continuing to monitor delays needed treatment, and telemetry removal is unsafe given arrhythmia risk.

Question 34

A client arrives in the emergency department complaining of chest pain that began 4 hours ago. A troponin T blood specimen is obtained, and the results indicate a level of 0.6 ng/mL. The nurse determines that this result indicates which finding?

Accepted Answer

Answer reason: A troponin T of 0.6 ng/mL is markedly elevated compared with typical normal values (near/under the lab cutoff, often

Question 35

A patient in the intensive care unit is diagnosed with septic shock. The nurse is monitoring the patient’s central venous pressure (CVP). What CVP measurement indicates the need for intervention?

Accepted Answer

Answer reason: In septic shock, patients often require fluid resuscitation early, but an excessively elevated CVP suggests fluid overload, impaired venous return, or right ventricular dysfunction and warrants prompt reassessment and treatment. A markedly high value is concerning for worsening hemodynamics and potential pulmonary edema or decreased cardiac output, especially if accompanied by respiratory distress or declining oxygenation. In contrast, values like 6–10 mm Hg are closer to typical targets used during resuscitation and are less likely to signal immediate harm by themselves without other findings.

Question 36

The nurse recognizes which factor in the client’s history is the most important etiological factor in developing a serum Mg of 4mEq/L?

Accepted Answer

Answer reason: Antacid use for peptic ulcer disease can be a direct source of significant magnesium load, especially with chronic or high-dose use. In contrast, chronic diarrhea from Crohn’s disease and ostomy output typically cause gastrointestinal magnesium losses leading to hypomagnesemia. Many CHF diuretics (particularly loop diuretics) also increase urinary magnesium loss rather than raise it, making that history less consistent with the elevated value.

Question 37

The nurse is caring for assigned clients and is reviewing laboratory data. Which laboratory data requires follow-up? A client with a?

Accepted Answer

Answer reason: A1C reflects average glycemic control over ~2–3 months, and values above the usual target indicate sustained hyperglycemia and increased risk for microvascular complications. An A1C of 7.5% exceeds the commonly tested goal of

Question 38

You are concerned that your patient, who is post-op from an abdominal hysterectomy, is developing an infection. Which of the following signs/symptoms could indicate infection?

Accepted Answer

Answer reason: A WBC of 13,800/μl is above the typical adult reference range and, in a post-op patient, should raise concern for infection (though it must be interpreted in context of trends and other findings). Clear yellow urine is expected and does not suggest UTI by itself. A tympanic temperature of 99.0°F is not a fever, and abdominal pain can be expected after abdominal surgery and is less specific than an abnormal lab suggesting infection.

Question 39

A child presents to the emergency room with deep/rapid respirations, fruity breath odor, and lethargy. Which lab value should the nurse assess first?

Accepted Answer

Answer reason: A bedside capillary glucose is the fastest, most immediately actionable assessment that guides initial emergency management (IV fluids, insulin protocol, and electrolyte monitoring). CBC and urinalysis may support evaluation for infection/ketonuria but do not change the first critical stabilization steps as quickly as glucose does. Troponin is not a priority in this classic pediatric DKA presentation unless there are specific cardiac symptoms or risk factors suggesting myocardial injury.

Question 40

Recognizing Hypokalemia A nurse is assessing a patient with a serum potassium level of 2.8 mEq/L. Which of the following findings should the nurse expect?

Accepted Answer

Answer reason: Hypokalemia reduces skeletal and cardiac muscle cell excitability by impairing membrane repolarization. This commonly produces generalized muscle weakness and characteristic ECG changes such as flattened T waves (often with ST depression and prominent U waves in more marked deficits). A potassium of 2.8 mEq/L is clinically significant and raises concern for dysrhythmias, so ECG findings consistent with low potassium are expected. In contrast, hyperactive bowel sounds/diarrhea and increased deep tendon reflexes are more typical of hyperkalemia or hypocalcemia-related neuromuscular irritability rather than hypokalemia.

Question 41

The charge nurse has received laboratory data for clients. Which situation requires the charge nurse’s intervention first?

Accepted Answer

Answer reason: A sodium level of 153 mEq/L indicates hypernatremia, which is especially concerning in a postoperative craniotomy client because it may signal complications such as dehydration, diabetes insipidus, or neurologic deterioration. This requires prompt evaluation and intervention. Option A shows normal ABG values. Option C shows a mildly elevated WBC consistent with infection but not immediately critical. Option D is within the therapeutic range for phenytoin (10–20 mcg/mL).

Question 42

The nurse is reviewing a client’s lab work to determine if a risk for coronary artery disease (CAD) is present. The nurse is most concerned when the results identify which of the following?

Accepted Answer

Answer reason: A total cholesterol level of ≥240 mg/dL is considered high and is strongly associated with increased risk for coronary artery disease. This represents a significant cardiovascular risk.

Question 43

The nurse is completing a health assessment of the female client with menorrhagia of unknown origin. Which serum laboratory result should the nurse carefully review?

Accepted Answer

Answer reason: Menorrhagia (excessive menstrual bleeding) significantly increases the risk of anemia due to chronic blood loss. Hemoglobin is the primary indicator used to assess oxygen-carrying capacity and detect anemia. Monitoring hemoglobin levels is essential to evaluate the severity of blood loss and guide treatment decisions. The other options (calcium, BUN, WBC) are not directly related to blood loss or anemia in this context.

Question 44

A client has been admitted to the hospital for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen level drops to?

Accepted Answer

Answer reason: A value of 15 mg/dL is within typical adult normal limits (about 10–20 mg/dL), indicating improved intravascular volume and kidney perfusion. A value of 29 or 35 mg/dL remains elevated and would suggest persistent hypovolemia or ongoing renal impairment. A value of 3 mg/dL is abnormally low and would not be an expected indicator of appropriate rehydration in this context.

Question 45

After obtaining an EKG on a patient you notice that ST depression is present along with an inverted T wave and prominent U wave. What lab value would be the cause of this finding?

Accepted Answer

Answer reason: Potassium level of 2.2 Hypokalemia characteristically causes ST-segment depression, T-wave flattening/inversion, and prominent U waves due to delayed ventricular repolarization. A value of 2.2 mEq/L represents severe hypokalemia and is strongly associated with these ECG changes and increased risk for dysrhythmias. In contrast, hyperkalemia (e.g., 5.6 mEq/L) more typically produces peaked T waves and QRS widening rather than U waves. The listed magnesium and phosphorus values do not best match the classic ST depression + inverted T + prominent U-wave pattern.

Question 46

Nurse Pete is reviewing the report of a client’s routine urinalysis. Which value should the nurse consider abnormal?

Accepted Answer

Answer reason: Urine pH of 3.0 Urine pH normally ranges about 4.5 to 8.0, reflecting the kidneys’ role in acid-base regulation. A pH of 3.0 is outside the expected physiologic range and suggests markedly acidic urine that warrants follow-up for causes such as severe systemic acidosis, starvation/ketosis, or certain medications/diets. By contrast, absence of glucose and absence of protein are normal findings on routine urinalysis. A specific gravity of 1.03 can be at the high end of normal and may reflect concentrated urine (e.g., dehydration) but is not inherently abnormal the way an extreme pH is.

Question 47

The primary health care provider prescribes arterial blood gas (ABG) analysis for a client receiving oxygen at 6L/min. Results show pH 7.37, HCO3 26mmHg, and pCO2 42mmHg, Po2 90mmHg. Which of the following should the nurse do first?

Accepted Answer

Answer reason: The pH, PaCO2, and HCO3 are all in expected ranges, indicating no acid–base imbalance, and the PaO2 of 90 mmHg reflects adequate oxygenation on the current therapy. Since there is no evidence of hypoxemia or ventilatory failure, increasing oxygen or initiating airway-expansion maneuvers is not the priority. The appropriate first nursing action is to record the normal results and continue routine monitoring, notifying the provider per policy if required.

Question 48

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

Accepted Answer

Answer reason: Pyuria (increased WBCs in the urine, often with positive leukocyte esterase and sometimes WBC casts) directly supports a UTI and, in the right clinical context, pyelonephritis. Myoglobinuria points to rhabdomyolysis, and ketonuria is most consistent with starvation or uncontrolled diabetes rather than kidney infection. A low systemic WBC count would not support infection; infection more often causes leukocytosis, not leukopenia (except in severe sepsis/immunosuppression).

Question 49

A nurse evaluates the blood theophylline level of a client receiving aminophylline (theophylline) by intravenous infusion. The nurse would determine that a therapeutic blood level exists if any of the following were noted in the laboratory report?

Accepted Answer

Answer reason: Therapeutic theophylline levels are typically about 10–20 mcg/mL in most clinical references, so this value fits within the target range for efficacy. Levels around 25–30 mcg/mL exceed the usual therapeutic window and raise concern for toxicity (e.g., nausea/vomiting, tachyarrhythmias, seizures). A level of 5 mcg/mL is generally subtherapeutic and may not provide adequate bronchodilation.

Question 50

Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?

Accepted Answer

Answer reason: A WBC of 1700/µl is markedly low and can indicate significant immunosuppression requiring prompt provider notification for neutropenic precautions, evaluation for infection, and possible treatment adjustments (e.g., growth factor support). While thrombocytopenia at 65,000/µl increases bleeding risk, it is generally less immediately fatal than overwhelming infection risk at this degree of leukopenia unless active bleeding is present. The creatinine value is within normal limits, and the hemoglobin value listed is not presented in a typical unit for reporting anemia severity in this context.

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