Cacapit, Lovely Rose S.

10/30/2020
NDA – NCOMAP1
50 LABORATORY AND DIAGNOSTICS QUESTIONS

1. 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?
A. Platelet count of 30,000/mm3
B. Hemoglobin level of 7.5 g/dL
C. Reticulocyte count of 6.5%
D. Eosinophil count of 700 cells/mm3
Rationale: 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.
2. 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?
A. Renal disease
B. Dehydration
C. Congestive heart failure
D. History of high dietary protein intake
Rationale: 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.
3. 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?
A. Phosphorus level of 6 mg/dL
B. Phosphorus level of 3 mg/dL
C. Phosphorus level of 4 mg/dL
D. Phosphorus level of 2 mg/dL
Rationale: 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.
4. When providing care for a female client with Addison disease, the nurse should be
alert for which of the following laboratory value?
 A. Potassium level of 3.2 mEq/L
B. Calcium level of 3.3 mEq/L
C. Sodium level of 150 mg/dL
D. Hematocrit level of 25%
Rationale: 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.
5. A client with Congestive heart failure is about to take a dose of furosemide (Lasix).
Which of the following potassium level, if noted in the client's record, should be reported
before giving the due medication?
A. 5.1 mEq/L
B. 4.9 mEq/L
C. 3.9 mEq/L
D. 3.3 mEq/L
Rationale: The normal potassium level is 3.5 to 5.5 mEq/L. Low potassium levels can be
dangerous, especially for people with CHF. Low potassium can cause fatal heart
arrhythmias.
6. A client went to the emergency room with sudden onset of high fever and
diaphoresis. Serum sodium was one of the laboratory test taken. Which of the following
values would you expect to see?
A. 130 mEq/L
B. 148 mEq/L
C. 143 mEq/L
D. 139 mEq/L
Rationale: The normal sodium level is 135-145 mEq/L. Diaphoresis and a high fever can
lead to free water loss through the skin, resulting in increased sodium level
(hypernatremia).
7. A client is brought to the emergency department states that he has accidentally been
taking two times his prescribed dose of Warfarin (Coumadin). After observing that the
client has no evidence of any obvious bleeding, the nurse should do which of the
following?
A. Draw a sample for activated partial thromboplastin time (aPPT) level
B. Draw a sample for prothrombin time (PT) level and international normalize ratio
(INR)
C. Prepare to administer Vitamin k
D. Prepare to administer Protamine sulfate
Rationale: The next action for the nurse to take is to draw a sample for INR and PT level
to check the client's anticoagulation status and risk for bleeding. These results will
provide information on how to manage the client either giving an antidote such as
Vitamin K or administering a blood transfusion. Option A: The aPTT determines the
effects of heparin therapy. Option C: The results of the INR and PT level will be needed
first. Option D: Protamine sulfate is the antidote for heparin overdose.
8. A male client with atrial fibrillation who is receiving maintenance therapy of warfarin
(Coumadin) has a prothrombin time of 37 seconds. Based on the result, the nurse will
follow which of the following doctor's order?
A. Administering the next dose of the warfarin
B. Increasing the next dose of warfarin
C. Decreasing the next dose of warfarin
D. Withholding the next dose of warfarin
Rationale: The normal prothrombin time is 9.6 to 11.8 seconds (male adult). A
therapeutic level PT level is 1.5 to 2 times higher than the normal level. Since the value
of 37 seconds is high, the nurse should expect that the client next dose of warfarin will
be withheld.
9. A client is receiving a continuous intravenous infusion of heparin sodium to treat deep
vein thrombosis. The client's activated partial thromboplastin time is 77 seconds. Based
on this result, the nurse anticipate which of the following prescription?
A. Maintain the rate of the heparin infusion
B. Decrease the rate of the heparin infusion
C. Increase the rate of the heparin infusion
D. Discontinue the heparin infusion
Rationale: The normal activated partial thromboplastin time is between 20 to 36
seconds. In the treatment of deep vein thrombosis, the therapeutic range is to maintain
the aPTT level between 1.5 and 2.5 times the normal. This means that the client's aPTT
level should not be less 30 seconds or greater than 90 seconds. Thus the client's aPTT
of 77 seconds is within the normal therapeutic range, and the dose/rate should not be
changed.
10. A nurse is handling a pregnant client who was prescribed to have an Alpha Feta
Protein level. The nurse should explain to the client that this blood test:
A. Can indicate lung disorders and neural tube defects
B. Abnormal levels are associated with an increased risk for chromosome
abnormality.
C. Once the Alpha Feta Protein level are abnormal, an amniocentesis will be
ordered.
D. An Alpha Feta Protein is a definitive test for neural tube defects.
Rationale: If the Alpha Feta Protein levels are abnormal, the physician will prescribe an
amniocentesis to confirm or eliminate the diagnosis of a neural tube defect. Option A is
incorrect since Alpha Feta Protein does not indicate lung disorders. Option B is incorrect
because an increase of human chorionic gonadotropin instead is associated with an
increased risk for chromosome abnormality. Option D is incorrect because an Alpha
Feta Protein level is a screening test and is not a definitive test. Option A is incorrect
since Alpha Feta protein does not indicate lung disorders. Option B is incorrect because
an increase of human chorionic gonadotropin instead is associated with an increased
risk for chromosome abnormality. Option D is incorrect because an Alpha Feta protein
level is a screening test and is not a definitive test.
11. Which of the following laboratory results indicates hypoparathyroidism?
A. Serum potassium of 3.6 mEq/L
B. Serum calcium level of 4.3 mEq/L
C. Serum phosphorus level of 5.7 mg/dL
D. Serum magnesium level of 1.7 mg/dL
Rationale: The parathyroid is responsible for the absorption of calcium and phosphorus.
When a client has hypoparathyroidism, the serum calcium levels are low and the serum
phosphorus levels are high. The normal phosphorus level is 2.7 to 4.5 mg/dL.
12. An adult male client has a hemoglobin count of 12.5 g/dL. Based on the result, the
client is most likely having this due to which of the following noted in the client's record?
A. Emphysema
B. Client living in a high altitude
C. Dehydration
D. History of enlarged spleen
Rationale: The normal hemoglobin level for an adult male is 14-16.5 g/dL. An enlarged
spleen may cause anemia (low hemoglobin count) in clients. Options A and B:
Emphysema and living at higher altitudes causes the red blood cell production to
naturally increases to compensate for the lower oxygen supply. Option C: Dehydration
may increase the hemoglobin level by hemoconcentration.
13. A screen test for detection of human immunodeficiency virus (HIV) reveals a
positive ELISA exam. Which of the following test will be used to confirm the diagnosis of
HIV?
A. Indirect immunofluorescence assay (IFA)
B. CD4-to-CD8 ratio
C. Radioimmunoprecipitation assay (RIPA) test
D. P24 antigen assay
Rationale: The indirect immunofluorescence assay (IFA) test and Western Blot test
result are considered as confirmatory for HIV. Option B: CD4-to-CD8 ratio monitors the
progression of HIV. Option C: Radioimmunoprecipitation assay (RIPA) test detects HIV
protein rather than showing antibodies. Option D: p24 antigen assay quantifies the
amount of HIV viral core protein.
14. The client went to the emergency room with a sudden onset of chest pain and
difficulty of breathing. Which of the following result is indicative that the client is
experiencing a myocardial infarction?
 A. Myoglobin level of 98 mcg/L
B. Troponin T of 0.09 ng/mL
C. Troponin I 0.5 ng/mL
D. Creatine kinase (CK-MB) 155 units/L
Rationale: The normal value of myoglobin is lower than 90 mcg/L; An elevation could
indicate a myocardial infarction. Options B, C, and D all have normal values.
15. 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:
A. 36 mg/dL
B. 27 mg/dL
C. 18 mg/dL
D. 6 mg/dL
Rationale: 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.
16. 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?
A. 6.9 g/dL
B. 4.9 g/dL
C. 2.9 g/dL
D. 0.9 g/dL
Rationale: 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.
17. 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?
A. 50 units/L
B. 150 units/L
C. 350 units/L
D. 650 units/L
Rationale: 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.
18. 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:
A. Maintaining the result
 B. Preventing hypoglycemia
C. Preventing hyperglycemia
D. Avoiding infection
Rationale: 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.
19. 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?
A. Give the next dose
B. Notify the physician
C. Check the client’s pulse rate
D. Increase the next dose as ordered.
Rationale: 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.
20. 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. None. This is a normal calcium level
B. Prolonged QT interval
C. Shortened ST segment
D. Widened T wave
Rationale: 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.
21. Randy has undergone kidney transplant; what assessment would prompt Nurse
Katrina to suspect organ rejection?
A. Sudden weight loss
B. Polyuria
C. Hypertension
D. Shock
Rationale: Option C: Hypertension, along with fever, and tenderness over the grafted
kidney, reflects acute rejection.
22. The immediate objective of nursing care for an overweight, mildly hypertensive male
client with ureteral colic and hematuria is to decrease:
A. Pain
B. Weight
C. Hematuria
 D. Hypertension
Rationale: Option A: Sharp, severe pain (renal colic) radiating toward the genitalia and
thigh is caused by urethral distention and smooth muscle spasm; relief from pain is the
priority.
23. Matilda, with hyperthyroidism, is to receive Lugol’s iodine solution before a subtotal
thyroidectomy is performed. The nurse is aware that this medication is given to:
A. Decrease the total basal metabolic rate
B. Maintain the function of the parathyroid glands
C. Block the formation of thyroxine by the thyroid gland
D. Decrease the size and vascularity of the thyroid gland
Rationale: Option D: Lugol’s solution provides iodine, which aids in decreasing the
vascularity of the thyroid gland, which limits the risk of hemorrhage when surgery is
performed.
24. Tracy is receiving combination chemotherapy for treatment of metastatic carcinoma.
Nurse Ruby should monitor the client for the systemic side effect of:
A. Ascites
B. Nystagmus
C. Leukopenia
D. Polycythemia
Rationale: Option C: Leukopenia, a reduction in WBCs, is a systemic effect of
chemotherapy as a result of myelosuppression.
25. Nurse Ron begins to teach a male client how to perform colostomy irrigations. The
nurse would evaluate that the instructions were understood when the client states, “I
should:
A. Lie on my left side while instilling the irrigating solution
B. Keep the irrigating container less than 18 inches above the stoma
C. Instill a minimum of 1200 ml of irrigating solution to stimulate evacuation of the
bowel
D. Insert the irrigating catheter deeper into the stoma if cramping occurs during the
procedure.
Rationale: Option B: This height permits the solution to flow slowly with little force so
that excessive peristalsis is not immediately precipitated.
26. Mario has burn injury. After 48 hours, the physician orders for Mario 2 liters of IV
fluid to be administered q12 h. The drop factor of the tubing is 10 gtt/ml. The nurse
should set the flow to provide:
A. 18 gtt/min
B. 28 gtt/min
C. 32 gtt/min
D. 36 gtt/min
Rationale: Option B: This is the correct flow rate; multiply the amount to be infused
(2000 ml) by the drop factor (10) and divide the result by the amount of time in minutes
(12 hours x 60 minutes)
27. Nurse Sherry is teaching male client regarding his permanent artificial pacemaker.
Which information given by the nurse shows her knowledge deficit about the artificial
cardiac pacemaker?
A. Take the pulse rate once a day, in the morning upon awakening
B. May be allowed to use electrical appliances
C. Have a regular follow up care
D. May engage in contact sports
Rationale: Option D: The client should be advised by the nurse to avoid contact sports.
This will prevent trauma to the area of the pacemaker generator.
28. Tonny has undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes
are inserted, and one-bottle water-seal drainage is instituted in the operating room. In
the postanesthesia care unit, Tonny is placed in Fowler’s position on either his right side
or on his back. The nurse is aware that this position:
A. Reduce incisional pain
B. Facilitate ventilation of the left lung
C. Equalize pressure in the pleural space
D. Increase venous return
Rationale: Option B: Since only a partial pneumonectomy is done, there is a need to
promote expansion of this remaining left lung by positioning the client on the opposite
unoperated side.
29. Kristine is scheduled for a bronchoscopy. When teaching Kristine what to expect
afterward, the nurse’s highest priority of information would be:
A. Food and fluids will be withheld for at least 2 hours.
B. Warm saline gargles will be done q 2h.
C. Coughing and deep-breathing exercises will be done q2h
D. Only ice chips and cold liquids will be allowed initially
Rationale: Option A: Prior to bronchoscopy, the doctors spray the back of the throat with
anesthetic to minimize the gag reflex and thus facilitate the insertion of the
bronchoscope. Giving the client food and drink after the procedure without checking on
the return of the gag reflex can cause the client to aspirate. The gag reflex usually
returns after two hours.
30. Nurse Tristan is caring for a male client in acute renal failure. The nurse should
expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to
treat:
A. Hypernatremia
B. Hypokalemia
 C. Hyperkalemia
D. Hypercalcemia
Rationale: Option C: Hyperkalemia is a common complication of acute renal failure. It’s
life-threatening if immediate action isn’t taken to reverse it. The administration of
glucose and regular insulin, with sodium bicarbonate, if necessary, can temporarily
prevent cardiac arrest by moving potassium into the cells and temporarily reducing
serum potassium levels. Options A, B, and D: Hypernatremia, hypokalemia, and
hypercalcemia don’t usually occur with acute renal failure and aren’t treated with
glucose, insulin, or sodium bicarbonate.
31. Jestoni with chronic renal failure (CRF) is admitted to the urology unit. The nurse is
aware that the diagnostic test is consistent with CRF if the result is:
A. Increase pH with decreased hydrogen ions
B. Increased serum levels of potassium, magnesium, and calcium.
C. Blood urea nitrogen (BUN) 100 mg/dL and serum creatinine 6.5 mg/dl
D. Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%
Rationale: Option C: The normal BUN level ranges 8 to 23 mg/dl; the normal serum
creatinine level ranges from 0.7 to 1.5 mg/dl. The test results in option C are abnormally
elevated, reflecting CRF and the kidneys’ decreased ability to remove nonprotein
nitrogen waste from the blood. Option A: CRF causes decreased pH and increased
hydrogen ions — not vice versa. Option B: CRF also increases serum levels of
potassium, magnesium, and phosphorous, and decreases serum levels of calcium.
Option D: A uric acid analysis of 3.5 mg/dl falls within the normal range of 2.7 to 7.7
mg/dl; PSP excretion of 75% also falls with the normal range of 60% to 75%.
32. Katrina has an abnormal result on a Papanicolaou test. After admitting that she read
her chart while the nurse was out of the room, Katrina asks what dysplasia means.
Which definition should the nurse provide?
A. Presence of completely undifferentiated tumor cells that don’t resemble cells of
the tissues of their origin
B. Increase in the number of normal cells in a normal arrangement in a tissue or an
organ.
C. Replacement of one type of fully differentiated cell by another in tissues where
the second type normally isn’t found
D. Alteration in the size, shape, and organization of differentiated cells.
Rationale: Option D: Dysplasia refers to an alteration in the size, shape, and
organization of differentiated cells. Option A: The presence of completely
undifferentiated tumor cells that don’t resemble cells of the tissues of their origin is
called anaplasia. Option B: An increase in the number of normal cells in a normal
arrangement in a tissue or an organ is called hyperplasia. Option C: Replacement of
one type of fully differentiated cell by another in tissues where the second type normally
isn’t found is called metaplasia.
33. Wilfredo with a recent history of rectal bleeding is being prepared for a colonoscopy.
How should the nurse Patricia position the client for this test initially?
A. Lying on the right side with legs straight
B. Lying on the left side with knees bent
C. Prone with the torso elevated
D. Bent over with hands touching the floor
Rationale: Option B: For a colonoscopy, the nurse initially should position the client on
the left side with knees bent. Option A, C, and D: Placing the client on the right side with
legs straight, prone with the torso elevated, or bent over with hands touching the floor
wouldn’t allow proper visualization of the large intestine.
34. A male client with inflammatory bowel disease undergoes an ileostomy. On the first
day after surgery, Nurse Oliver notes that the client’s stoma appears dusky. How should
the nurse interpret this finding?
A. Blood supply to the stoma has been interrupted
B. This is a normal finding 1 day after surgery
C. The ostomy bag should be adjusted
D. An intestinal obstruction has occurred.
Rationale: Option A: An ileostomy stoma forms as the ileum is brought through the
abdominal wall to the surface skin, creating an artificial opening for waste elimination.
The stoma should appear cherry red, indicating adequate arterial perfusion. A dusky
stoma suggests decreased perfusion, which may result from interruption of the stoma’s
blood supply and may lead to tissue damage or necrosis. Option B: A dusky stoma isn’t
a normal finding. Option C: Adjusting the ostomy bag wouldn’t affect stoma color, which
depends on blood supply to the area. Option D: An intestinal obstruction also wouldn’t
change stoma color.
35. A male client has a reduced serum high-density lipoprotein (HDL) level and an
elevated low-density lipoprotein (LDL) level. Which of the following dietary modifications
is not appropriate for this client?
A. Fiber intake of 25 to 30 g daily
B. Less than 30% of calories from fat
C. Cholesterol intake of less than 300 mg daily
D. Less than 10% of calories from saturated fat
Rationale: Option B: A client with low serum HDL and high serum LDL levels should get
less than 30% of daily calories from fat. Options A, C, and D: The other modifications
are appropriate for this client.
36. A male client arriving in the emergency department is receiving cardiopulmonary
resuscitation from paramedics who are giving ventilations through an endotracheal (ET)
tube that they placed in the client’s home. During a pause in compressions, the cardiac
monitor shows narrow QRS complexes and a heart rate of beats/minute with a palpable
pulse. Which of the following actions should the nurse take first?
 A. Start an L.V. line and administer amiodarone, 300 mg L.V over 10 minutes
B. Check endotracheal tube placement
C. Obtain an arterial blood gas sample
D. Administer atropine, 1 mg L.V.
Rationale: Option B: ET tube placement should be confirmed as soon as the client
arrives in the emergency department. Once the airways is secured, oxygenation and
ventilation should be confirmed using an end-tidal carbon dioxide monitor and pulse
oximetry. Option A: Next, the nurse should make sure L.V. access is established.
Option D: If the client experiences symptomatic bradycardia, atropine is administered as
ordered 0.5 to 1 mg every 3 to 5 minutes to a total of 3 mg. Option C: Then the nurse
should try to find the cause of the client’s arrest by obtaining an ABG sample.
Amiodarone is indicated for ventricular tachycardia, ventricular fibrillation, and atrial
flutter – not symptomatic bradycardia.
37. After cardiac surgery, a client’s blood pressure measures 126/80 mm Hg. Nurse
Katrina determines that mean arterial pressure (MAP) is which of the following?
A. 46 mmHg
B. 80 mmHg
C. 95 mmHg
D. 90 mmHg
Rationale: Option C: Use the following formula to calculate MAP MAP = systolic + 2
(diastolic) MAP = 126 mm Hg + 2 (80 mm Hg) MAP = 286 mm Hg MAP = 95 mm Hg
38. Macario had coronary artery bypass graft (CABG) surgery 3 days ago. Which of the
following conditions is suspected by the nurse when a decrease in platelet count from
230,000 ul to 5,000 ul is noted?
A. Pancytopenia
B. Idiopathic thrombocytopenic purpura (ITP)
C. Disseminated intravascular coagulation (DIC) \
D. Heparin-associated thrombosis and thrombocytopenia (HATT)
Rationale: Option D: HATT may occur after CABG surgery due to heparin use during
surgery. Options B and C: Although DIC and ITP cause platelet aggregation and
bleeding, neither is common in a client after revascularization surgery. Option A:
Pancytopenia is a reduction in all blood cells.
39. An 18-year-old male client admitted with heat stroke begins to show signs of
disseminated intravascular coagulation (DIC). Which of the following laboratory findings
is most consistent with DIC?
A. Low platelet count
B. Elevated fibrinogen levels
C. Low levels of fibrin degradation products
D. Reduced prothrombin time
Rationale: Option A: In DIC, platelets and clotting factors are consumed, resulting in
microthrombi and excessive bleeding. As clots form, fibrinogen levels decrease and the
prothrombin time increases. Fibrin degradation products increase as fibrinolysis takes
places.
40. A male client with a gunshot wound requires an emergency blood transfusion. His
blood type is AB negative. Which blood type would be the safest for him to receive?
A. AB Rh-positive
B. A Rh-positive
C. A Rh-negative
D. O Rh-positive
Rationale: Option C: Human blood can sometimes contain an inherited D antigen.
Persons with the D antigen have Rh-positive blood type; those lacking the antigen have
Rh-negative blood. It’s important that a person with Rh-negative blood receives Rh-
negative blood. If Rh-positive blood is administered to an Rh-negative person, the
recipient develops anti-Rh agglutinins, and subsequent transfusions with Rh-positive
blood may cause serious reactions with clumping and hemolysis of red blood cells.
41. The nurse checks the laboratory result for a serum digoxin level that was prescribed
for a client earlier in the day and notes that the result is 2.4 ng/mL. The nurse should
take which immediate action?
A. Check the client’s pulse rate
B. Notify the health care provider
C. Record the normal value on the client’s flow sheet
D. Administer the next dose of the medication as scheduled.
Rationale: The normal therapeutic range for digoxin is 0.5 to 2 ng/mL. A level of 2.4
ng/mL exceeds the therapeutic range and indicates toxicity. The nurse should notify the
HCP, who may give further prescriptions about holding further doses of digoxin. The
option that indicates to record the normal value on the client's flow sheet is incorrect
because the level is not normal. The next dose should not be administered because the
serum digoxin level exceeds the therapeutic range. Checking the client's last pulse rate
may have limited value in this situation. Depending on the time that has elapsed since
the last assessment, a current assessment of the client's status may be more useful.
42. Several laboratory tests are prescribed for a client, and the nurse reviews the results
of the tests. Which abnormal laboratory results should the nurse report? Select all that
apply.
A. Calcium, 7 mg/dL
B. Magnesium, 1 mg/dL
C. Phosphorus, 3.6 mg/dL
D. Neutrophils, 1000 cells/mm3
E. Serum creatinine, 1 mg/dL
F. White blood cells, 3000 cells/mm3
Rationale: The normal values include the following: calcium, 8.6 to 10 mg/dL;
magnesium, 1.6 to 2.6 mg/dL; phosphorus 2.7 to 4.5 mg/dL; neutrophils, 1800 to 7800
cells/mm3; serum creatinine, 0.6 to 1.3 mg/dL; and white blood cells, 4500 to 11,000
cells/mm3. The calcium level noted is low; the magnesium level noted is low; the
phosphorus level noted is normal; the neutrophil level noted is low; the serum creatinine
level noted is normal; and the white blood cell level is low.
43. An adult client with cirrhosis has been prescribed a diet with optimal amounts of
protein. The nurse evaluates the client's status as being most satisfactory if the total
protein is which value?
A. 0.4 g/dL
B. 3.7 g/dL
C. 6.4 g/dL
D. 9.8 g/dL
Rationale: The normal range for total serum protein level in the adult client is 6 to 8
g/dL. The client with cirrhosis often has low total protein levels as a result of inadequate
nutrition. Excess protein is not helpful, though, because a function of the liver is to
metabolize protein. A diseased liver may not metabolize protein well. The options of 0.4
g/dL. and 3.7 g/dL identify low values, and 9.8 g/dL identifies a high protein value.
44. The nurse is assigned to a 40-year-old client who has a diagnosis of chronic
pancreatitis. The nurse anticipates the client's serum amylase level to be which value?
A. 45 units/L
B. 100 units/L
C. 300 units/L
D. 500 units/L
Rationale: The normal serum amylase level is 25 to 151 units/L. With chronic cases of
pancreatitis, the rise in serum amylase levels usually does not exceed three times the
normal value. In acute pancreatitis, the value may exceed five times the normal value.
The options of 45 units/L and 100 units/L are within normal limits. The option of 500
units/L is an extremely elevated level seen in acute pancreatitis.
45. An adult female client has a hemoglobin level of 10.8 g/dL. he nurse interprets that
his result is most likely caused by which condition noted in the client's history?
A. Dehydration
B. Heart failure
C. Iron deficiency anemia
D. COPD
Rationale: The normal hemoglobin level for an adult female client is 12 to 15 g/dL. Iron
deficiency anemia can result in lower hemoglobin levels. Dehydration may increase the
hemoglobin levels by hemoconcentration. Heart failure and chronic obstructive
pulmonary disease may increase the hemoglobin level as a result of the body's need for
more oxygen carrying capacity.
46. A client with a history of gastrointestinal bleeding has a platelet count of 300,000
cells/mm3. The nurse should take which action after seeing the laboratory results?
A. Report the abnormally low count
B. Report the abnormally high count
C. Place the client on bleeding precautions
D. Place the normal report in the client’s medical record
Rationale: A normal platelet count ranges from 150,000 to 400,000 cells/mm3. The
nurse should place the report containing the normal laboratory value in the client's
medical record. A platelet count of 300,000 cells/mm3 is not an elevated count. The
count also is not low; therefore bleeding precautions are not needed.
47. The nurse is caring for a client receiving intravenous nitroglycerin for acute angina.
What is the most important assessment during treatment?
A. Heart rate
B. Urine output
C. Neurologic status
D. Blood pressure
Rationale: The vasodilatation that occurs as a result of this medication can cause
profound hypotension. The client's blood pressure must be evaluated every 15 minutes
until stable and then every 30 minutes to every hour.
48. The nurse is assessing a woman in early labor. While positioning for a vaginal
exam, she complains of dizziness and nausea and appears pale. Her blood pressure
has dropped slightly. What should be the initial nursing action?
A. Call the health care provider
B. Elevate the foot of the bed
C. Encourage deep breathing
D. Turn her to her left side
Rationale: The weight of the uterus can put pressure on the vena cava and aorta when
a pregnant woman is flat on her back causing supine hypotension. Action is needed to
relieve the pressure on the vena cava and aorta. Turning the woman to the side
reduces this pressure and relieves postural hypotension.
49. When teaching a client about an oral hypoglycemic medication, the nurse should
place primary emphasis on
A. Recognizing findings of toxicity
B. Taking the medication at specified times
C. Increasing the dosage based on blood glucose
D. Distinguishing hyperglycemia
Rationale: A regular interval between doses should be maintained since oral
hypoglycemics stimulate the islets of Langerhans to produce insulin.
50. The nurse is teaching a group of college students about breast self-examination. A
woman asks for the best time to perform the monthly exam. What is the best reply by
the nurse?
A. “the first of every month, because it is easiest to remember”
B. “right after the period, when your breast are less tender”
C. “do the exam at the same time every month”
D. “ovulation, or mid-cycle is the best time to detect changes”
Rationale: The best time for a breast self-exam (BSE) is a week after a menstrual cycle,
when the breasts are no longer swollen and tender due to hormone elevation.