A nurse is reviewing the complete blood count (CBC) of a child who has been diagnosed with idiopathic thrombocytopenic purpura. Which of the following laboratory result should the nurse report immediately to the physician?
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Solution
Hemoglobin level of 7.5 g/dL.
The low hemoglobin level indicates that the client has an active bleeding, and immediate actions such as additional diagnostic exam and blood transfusions can be suggested.
Options A, C, and D: Decreased platelet count, increased reticulocyte and increased eosinophil count are expected in a child with idiopathic thrombocytopenic purpura.
A female client went to the clinic with a creatine clearance of 200 mL/min. Which of the following condition of the client can cause the increased level of this test?
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Solution
History of high dietary protein intake.
The normal creatine clearance for a female is 88 to 128 ml/min. An increased creatinine clearance is often referred to as hyperfiltration and is most commonly seen during pregnancy or in clients with a large dietary protein intake.
Options A, B, and C are seen with a decreased creatinine clearance.
A client has been undergoing radiotherapy for the treatment of mandibular cancer. After a few sessions, the client is diagnosed with Tumor Lysis Syndrome (TLS). Which of the following findings correlates with TLS?
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Solution
Phosphorus level of 6 mg/dL.
Tumor lysis syndrome (TLS) is a potentially life-threatening metabolic disorder characterized by elevated phosphorus levels. The normal phosphorus is 2.5 to 4.5 mg/dL.
When providing care for a female client with Addison disease, the nurse should be alert for which of the following laboratory value?
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Solution
Hematocrit level of 25%.
A client with Addison’s disease is at risk for anemia. The normal hematocrit level of a female adult is 35% to 45%. A client with anemia has a low hematocrit level.
Options A and B: Client with Addison’s disease have an increased potassium and calcium level.
Option C: Client with Addison’s disease have a low sodium level.
The nurse caring for a client with a serum calcium of 6.8 mg/dL. What would the nurse expect the change on the electrocardiogram (ECG)?
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Solution
Prolonged QT interval.
The normal serum calcium level is 8.6 to 10 mg/dL. A serum calcium level lower than 8.6 mg/dL indicates hypocalcemia. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT interval.
Options C and D: A shortened ST segment and a widened T wave occur with hypercalcemia.
The nurse is reviewing the laboratory result of a client receiving digoxin (Lanoxin) and notes that the result is 2.5 ng/mL. The nurse plans to do which of the following?
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Solution
Notify the physician.
The normal value therapeutic range for digoxin is 0.5 to 2 ng/mL. A level of 2.5 ng/mL indicates a toxicity. The nurse should immediately inform the physician, who may give further instructions about holding the next doses of digoxin.
A client with diabetes mellitus has a glycosylated hemoglobin A1c level of 10%. Based on the result, the nurse plans to teach the client about the importance of:
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Solution
Preventing hyperglycemia.
Glycosylated hemoglobin A1c level of 8% higher indicates a poor diabetic control. Elevations indicate continued need for a teaching related to the prevention of hyperglycemic episodes.
The nurse is handling a client with chronic pancreatitis. Upon reviewing the client’s record, which of the following serum amylase level is to be expected?
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Solution
350 units/L.
The normal serum amylase level is 25 to 151 unit/L. Clients with chronic pancreatitis have an increased level of serum amylase which does not exceed three times the normal value.
Options A and B are within the normal values.
Option D is seen with acute pancreatitis since the value may exceed five times the normal value.
A client with liver cirrhosis has been advised to follow a high-protein diet. The nurse evaluates the effectiveness of the diet if the total protein level is which of the following values?
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Solution
6.9 g/dL.
The normal value for total serum protein is 6 to 8 g/dL. The client with liver cirrhosis has low total protein levels secondary to inadequate nutrition.
Options B, C, and D are abnormal values.
A nurse is caring for a client with diarrhea and dehydration. The nurse determines that the client has received adequate fluid replacement if the blood urea nitrogen decreases to:
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Solution
18 mg/dL.
The normal value of blood urea nitrogen is 8 to 25 mg/dL.
Options A and B still indicates dehydration.
Option D which has a low BUN occurs with conditions such as fluid volume overload, malnutrition, etc.