Question 1

An older patient takes warfarin.The patient's international normalized ratio (INR)is 1.0.What action by the nurse is best?
A)Nothing;this level is therapeutic.
B)Assess the patient's diet history.
C)Prepare to administer vitamin K.
D)Double the warfarin dose.

Accepted Answer

The INR (International Normalized Ratio) for a patient on warfarin should typically be between 2.0 and 3.0 for most indications. An INR of 1.0 is too low, indicating that the warfarin is not effectively anticoagulating the blood. Assessing the patient's diet is important because vitamin K intake can affect warfarin's effectiveness.

Question 2

A patient was admitted for heart failure,and over the past 3 days the patient's brain natriuretic peptide has increased.What action by the nurse is best?
A)Prepare to administer extra diuretics.
B)Continue with the plan of care.
C)Prepare to intubate and ventilate the patient.
D)Discuss end-of-life care with the patient.

Accepted Answer

An increase in brain natriuretic peptide indicates worsening heart failure and extra diuretics may be needed to help manage symptoms and prevent further complications. Continuing with the plan of care may not be enough to address the worsening condition. Intubating and ventilating the patient or discussing end-of-life care may be premature actions without first attempting to manage the heart failure exacerbation with medication.

Question 3

An older female patient develops gout and says,"Why did I get this now?" What response by the nurse is best?
A)"Gout can strike anyone at any time."
B)"Your body apparently makes more uric acid now."
C)"Uric acid rarely rises until after menopause."
D)"Women actually have more gout than men do."

Accepted Answer

Gout is more common in men, but in women, the risk increases after menopause. This is because estrogen, which helps the kidneys remove uric acid, decreases after menopause, leading to higher levels of uric acid in the body, which can cause gout.

Question 4

An older adult has been admitted for dehydration.Which laboratory value correlates with this condition?
A)Na+: 160 mEq/L
B)Na+: 128 mEq/L
C)K+: 3.5 mEq/L
D)K+: 5.2 mEq/L

Accepted Answer

A) Na+: 160 mEq/L indicates hypernatremia, which is often associated with dehydration as it reflects a higher concentration of sodium in the blood due to reduced body water.

Question 5

The student asks the registered nurse for information about the older patient's erythrocyte sedimentation rate (ESR).What information does the nurse provide? (Select all that apply. )
A)An elevated ESR indicates an inflammatory process in occurring.
B)A decreased ESR indicates the patient has an active infection.
C)Mild elevations in ESR may be a normal age-related change.
D)An elevated ESR is diagnostic for some type of cancer.
E)ESR findings should be interpreted in light of the clinical picture.

Accepted Answer

An elevated ESR indicates an inflammatory process is occurring, which could be due to a variety of reasons such as infection, autoimmune diseases, or cancer. Mild elevations in ESR may be a normal age-related change. ESR findings should be interpreted in light of the clinical picture, as it is not a specific test and can be influenced by many factors. A decreased ESR does not necessarily indicate an active infection. An elevated ESR alone is not diagnostic for cancer.

Question 6

A patient's oxygen saturation is 98%,but the patient reports shortness of breath with activity.What action by the nurse is best?
A)Assess the patient's hemoglobin.
B)Apply oxygen at 2 L/nasal cannula.
C)Consult respiratory therapy.
D)Administer a bronchodilator.

Accepted Answer

Assessing the patient's hemoglobin is the best initial action because a normal oxygen saturation does not rule out other causes of shortness of breath, such as anemia, which can be identified by checking the hemoglobin level.

Question 7

The leukocyte count of an older adult patient is elevated.Understanding the effects of aging on body functions,what action by the nurse is best?
A)Check for drug allergies before requesting an antibiotic prescription.
B)Take vital signs and perform a head to toe assessment.
C)Encourage the patient to drink several glasses of water.
D)Collect a urinalysis as soon as possible,having the patient produce a urine sample and requesting a stat urinalysis.

Accepted Answer

An elevated leukocyte count can indicate infection or inflammation, but it can also be a normal age-related change. Taking vital signs and performing a head to toe assessment can help the nurse determine if there are any other signs or symptoms of infection or inflammation present. This can guide further interventions or diagnostic testing. Checking for drug allergies before requesting an antibiotic prescription or collecting a urinalysis may be appropriate depending on the results of the assessment, but these options alone do not provide enough information to determine the best course of action. Encouraging the patient to drink several glasses of water may be helpful in general, but it is not a specific intervention for an elevated leukocyte count.

Question 8

An older patient has a pressure ulcer that is resistant to healing despite aggressive therapy and has developed pitting pedal edema.The patient's albumin is 3.4 g/dL.What action by the nurse is best?
A)Request a prealbumin level from the provider.
B)Document the finding as normal for age.
C)Consult the Wound-Ostomy nurse.
D)Review the results of the patient's BNP.

Accepted Answer

A low albumin level indicates poor nutritional status and may contribute to poor wound healing. Requesting a prealbumin level from the provider can provide further information about the patient's nutritional status and guide the development of an appropriate plan of care. Documentation of the edema as normal for age is incorrect and does not address the underlying issue. Consulting a Wound-Ostomy nurse may be helpful, but addressing the nutritional status is a priority. Reviewing the patient's BNP is not relevant to the issue of poor wound healing and edema.

Question 9

The nurse suspects that an older postoperative patient is developing a wound infection.What data best supports this inference? A)A thrombocyte count of 40,000/mm³ B)Decreasing erythrocyte sedimentation rate C)Increasing C-reactive protein level D)Increased partial prothrombin time

Accepted Answer

An increasing C-reactive protein level is a marker of inflammation and is often used to detect infection in the body. The other options are not specific to wound infection and may indicate other issues, such as a low thrombocyte count indicating thrombocytopenia or an increased partial prothrombin time indicating a clotting disorder. A decreasing erythrocyte sedimentation rate may indicate resolution of an inflammatory process.

Question 10

A patient has increased total iron binding capacity and transferrin levels.What action by the nurse is best? A)Prepare to administer vitamin B₁₂. B)Encourage the patient to eat protein. C)Ensure the patient gets sun exposure. D)Prepare the patient for chelating therapy.

Accepted Answer

Increased total iron binding capacity and transferrin levels typically indicate iron deficiency. Encouraging the patient to eat more protein can help increase iron intake, as many protein-rich foods are also good sources of iron.

Question 11

An older adult patient is experiencing symptoms commonly associated with hyperglycemia.Which laboratory test is most reliable for detecting hyperglycemia in older adults?
A)A random serum glucose
B)An oral glucose tolerance test
C)An early morning urine test for glucose
D)A 24-hour urine glucose test

Accepted Answer

An oral glucose tolerance test is the most reliable test for detecting hyperglycemia as it measures the body's ability to metabolize glucose and can diagnose diabetes or prediabetes.

Question 12

A patient is in the Emergency Department with chest pain and shortness of breath.Which laboratory result does the nurse review as the priority?
A)Troponin
B)Creatinine
C)Creatine kinase
D)Lactate dehydrogenase

Accepted Answer

Troponin is a cardiac-specific enzyme that is released into the bloodstream when there is damage to the heart muscles. Elevated troponin levels are indicative of a heart attack, and prompt intervention is essential in reducing the damage to the heart muscle. Therefore, it is important for the nurse to review the troponin levels as a priority.

Question 13

An older patient's BUN is 28 mg/dL and creatinine is 0.6 mg/dL.How does the nurse interpret these findings?
A)Normal for all age groups
B)Normal for older adults
C)High for all age groups
D)Low for older adults

Accepted Answer

The BUN and creatinine levels are within the normal range for older adults, indicating that kidney function is adequate for this age group. However, it is important to note that normal ranges may vary depending on the laboratory's reference values.

Question 14

An 85-year-old patient's blood gasses are as follows: pH 7.4,PaO₂ 75 mmHg,PaCO₂ 38.A patient's brain natriuretic peptide (BNP)was elevated on admission from the emergency department.Two days later,it has been reduced by half.What explanation of these findings by the nurse is best? A)"It shows your heart failure may be resolving." B)"Your heart is pumping much better now." C)"The ventricles can relax to hold more blood." D)"Your heart attack was not too serious."

Accepted Answer

The decrease in brain natriuretic peptide (BNP) indicates that the patient's heart failure may be resolving, which is supported by the patient's blood gas values being within normal range.

Question 15

The nurse helps minimize an older adult patient's risk of developing pernicious anemia by which of the following actions? A)Suggesting supplementing vitamin A B)Encouraging regular intake of citrus C)Identifying iron-rich foods D)Suggesting supplementing vitamin B₁₂

Accepted Answer

Pernicious anemia is caused by a deficiency in vitamin B12, so suggesting supplementing vitamin B12 can help minimize the risk of developing this condition. Vitamin A, citrus, and iron are not directly related to the prevention of pernicious anemia.

Question 16

A patient has heart failure and takes spironolactone.What diet selection from the menu shows that the patient needs more education?
A)A low-fat chicken salad sandwich
B)Salt-free vegetable soup
C)Broiled fish with lemon
D)Salt substitute and pepper

Accepted Answer

Spironolactone is a potassium-sparing diuretic, which means it helps the body retain potassium. Salt substitutes often contain potassium and can lead to high potassium levels in the blood, which can be dangerous for patients with heart failure. The patient needs education about avoiding salt substitutes and other high-potassium foods. The other options on the menu are appropriate for a patient with heart failure.

Question 17

The nurse is caring for an 88-year-old patient who was admitted to the long-term care facility after a series of "accidents" at home.The resident's folic acid level is 2 ng/mL.What action by the nurse is best?
A)Orders a high calorie,high protein diet.
B)Performs a comprehensive nutrition assessment
C)Assesses the patient for alcohol abuse.
D)Notifies the patient's provider for further orders.

Accepted Answer

A low folic acid level can be associated with alcohol abuse, so assessing the patient for alcohol abuse is a relevant action.

Question 18

A 66-year-old patient has a calcium level of 7.8 mg/dL.The nurse anticipates which other lab result?
A)Sodium level 162 mEq/L
B)Phosphorus level 5.2 mg/dL
C)Magnesium level 1.1 mg/dL
D)Glucose level: 138 mg/dL

Accepted Answer

Calcium and phosphorus have an inverse relationship, so a low calcium level may indicate a high phosphorus level. The other lab results listed do not have a direct relationship with calcium levels.

Question 19

On assessing the laboratory data of an older adult patient,the nurse notes the serum potassium level is 5.3 mEq/L.What action by the nurse is best?
A)Asks if the patient has been using a nonsteroidal antiinflammatory drug (NSAID).
B)Determines if the patient is receiving a diuretic that promotes potassium loss.
C)Suggests several potassium-rich foods to supplement dietary potassium intake.
D)Monitors the patient's urinary output for possible fluid retention.

Accepted Answer

The serum potassium level of 5.3 mEq/L is slightly elevated, indicating hyperkalemia. NSAIDs can cause potassium retention, so it's important to assess if the patient is using them.

Question 20

A 71-year-old patient has a triglyceride level of 112 mg/dL.What action by the nurse is best?
A)Assess the patient for cardiovascular risk factors.
B)Educate the patient on a lower-fat diet.
C)Congratulate the patient for a normal result.
D)Document the findings in the patient's chart.

Accepted Answer

Triglycerides are a type of fat found in the blood. High levels of triglycerides can increase the risk of cardiovascular disease. Therefore, the nurse should assess the patient for cardiovascular risk factors and educate the patient on a lower-fat diet.

Quiz 15: Laboratory and Diagnostic Tests

An older patient takes warfarin.The patient's international normalized ratio (INR) is 1.0.What action by the nurse is best?

A patient was admitted for heart failure,and over the past 3 days the patient's brain natriuretic peptide has increased.What action by the nurse is best?

An older female patient develops gout and says,"Why did I get this now?" What response by the nurse is best?

An older adult has been admitted for dehydration.Which laboratory value correlates with this condition?

The student asks the registered nurse for information about the older patient's erythrocyte sedimentation rate (ESR) .What information does the nurse provide? (Select all that apply. )

A patient's oxygen saturation is 98%,but the patient reports shortness of breath with activity.What action by the nurse is best?

The leukocyte count of an older adult patient is elevated.Understanding the effects of aging on body functions,what action by the nurse is best?

An older patient has a pressure ulcer that is resistant to healing despite aggressive therapy and has developed pitting pedal edema.The patient's albumin is 3.4 g/dL.What action by the nurse is best?

The nurse suspects that an older postoperative patient is developing a wound infection.What data best supports this inference?

A patient has increased total iron binding capacity and transferrin levels.What action by the nurse is best?

An older adult patient is experiencing symptoms commonly associated with hyperglycemia.Which laboratory test is most reliable for detecting hyperglycemia in older adults?

A patient is in the Emergency Department with chest pain and shortness of breath.Which laboratory result does the nurse review as the priority?

An older patient's BUN is 28 mg/dL and creatinine is 0.6 mg/dL.How does the nurse interpret these findings?

An 85-year-old patient's blood gasses are as follows: pH 7.4,PaO₂ 75 mmHg,PaCO₂ 38.A patient's brain natriuretic peptide (BNP) was elevated on admission from the emergency department.Two days later,it has been reduced by half.What explanation of these findings by the nurse is best?

The nurse helps minimize an older adult patient's risk of developing pernicious anemia by which of the following actions?

A patient has heart failure and takes spironolactone.What diet selection from the menu shows that the patient needs more education?

The nurse is caring for an 88-year-old patient who was admitted to the long-term care facility after a series of "accidents" at home.The resident's folic acid level is 2 ng/mL.What action by the nurse is best?

A 66-year-old patient has a calcium level of 7.8 mg/dL.The nurse anticipates which other lab result?

On assessing the laboratory data of an older adult patient,the nurse notes the serum potassium level is 5.3 mEq/L.What action by the nurse is best?

A 71-year-old patient has a triglyceride level of 112 mg/dL.What action by the nurse is best?