Question 1

When reviewing the laboratory results for an adult patient with elevated parathyroid hormone (PTH), which other laboratory result should the nurse interpret as significant?
A)Alanine aminotransferase (ALT)850 units/L
B)Alkaline phosphatase (ALP)250 units/L
C)Aspartate aminotransferase (AST)650 units/L
D)Creatine phosphokinase (CK)360 units/L

Accepted Answer

An elevated level of alkaline phosphatase is associated with increased bone turnover and can be indicative of hyperparathyroidism, which causes excess bone resorption. ALT, AST, and CK are markers of liver and muscle function and are not directly related to parathyroid hormone levels.

Question 2

A patient's laboratory test results indicate a negative finding on an infectious mononucleosis screen.The health-care provider, however, is concerned that this result could be a false-negative due to an interfering factor.Which of the following could cause such a false-negative finding?
A)Cocaine addition
B)Lymphoma
C)Hepatitis
D)Test conducted fewer than 6 days after exposure to the virus

Accepted Answer

The laboratory test for infectious mononucleosis should be performed no sooner than 6 days after exposure to the virus, as it takes time for the body to produce antibodies that can be detected in the test. Testing too soon could result in false-negative results. Cocaine addiction, lymphoma, and hepatitis do not typically interfere with the accuracy of the test.

Question 3

A patient diagnosed with hepatitis B reports easy bruising and bleeding with minor skin trauma.Which lab result should a nurse relate to this finding? A)Hematocrit of 40% B)Platelet count of 200,000/mm³ C)PT of 22 seconds D)PTT of 35 seconds

Accepted Answer

A prolonged Prothrombin Time (PT) of 22 seconds indicates a clotting disorder, which can explain the patient's symptoms of easy bruising and bleeding. PT measures the time it takes for blood to clot, and a prolonged PT can be seen in liver disease, such as hepatitis B, due to impaired synthesis of clotting factors.

Question 4

The results of a patient's adrenocorticotropic hormone (ACTH)test show a decreased cortisol level and an increased ACTH level.Which of the following conditions do these results most likely indicate?
A)Addison's disease
B)Cushing's disease
C)Cushing's syndrome related to ectopic source of ACTH
D)Cushing's syndrome (ACTH-independent)

Accepted Answer

The decreased cortisol level and increased ACTH level indicate primary adrenal insufficiency, also known as Addison's disease. In this condition, the adrenal cortex is damaged and cannot produce enough hormones, leading to a decrease in cortisol and an increase in ACTH secretion from the pituitary gland. This is in contrast to Cushing's disease, which is characterized by increased cortisol secretion due to a pituitary tumor, or Cushing's syndrome related to an ectopic source of ACTH, which is characterized by increased cortisol secretion due to an ACTH-producing tumor outside of the pituitary gland. Cushing's syndrome (ACTH-independent) is characterized by increased cortisol secretion due to an adrenal tumor or other non-pituitary source, but in this case, the ACTH level would be low.

Question 5

A patient with a serum phosphate level of 1.1 mg/dL is receiving IV sodium phosphate.When administering sodium phosphate, a nurse should monitor closely for:
A)Laryngeal stridor, dysphagia, and circumoral numbness
B)Lethargy, decreased deep tendon reflexes, and somnolence
C)Nausea, vomiting, and diarrhea
D)Weakness, confusion, and constipation

Accepted Answer

IV sodium phosphate administration can cause hyperphosphatemia and subsequent hypocalcemia, leading to symptoms such as laryngeal stridor, dysphagia, and circumoral numbness which are indicative of severe hypocalcemia. The nurse should also monitor for other symptoms such as tetany, seizures, and cardiac arrhythmias.

Question 6

A nurse assessing a patient with a history of inflammatory bowel disease notes bilateral pitting edema of both the ankles and feet.Which laboratory result is most likely related to this finding?
A)Decreased albumin
B)Elevated triglycerides
C)Elevated cholesterol
D)Elevated platelet count

Accepted Answer

Pitting edema is commonly associated with hypoalbuminemia, which is a decrease in the levels of albumin, a protein that helps regulate fluid balance in the body. Inflammatory bowel disease can cause malabsorption and malnutrition, leading to decreases in albumin levels and subsequent fluid accumulation in the extremities. Elevated triglycerides and cholesterol levels and an elevated platelet count are not directly related to pitting edema.

Question 7

A patient who is maintained on total parenteral nutrition (TPN)due to an exacerbation of inflammatory bowel disease has a ceruloplasmin level of 17 mg/dL.For which clinical manifestation should a nurse assess this patient?
A)Arthralgia or migratory joint pain
B)Chest pain or mental status changes
C)Increased white blood cell (WBC)count and fever
D)Jaundice or change in eye color

Accepted Answer

A low ceruloplasmin level is associated with Wilson's disease, a genetic disorder that causes excess accumulation of copper in the body. This can result in liver damage and eventually lead to jaundice and a change in eye color.

Question 8

A patient is suspected of having Wegener's syndrome.Which of the following antibody tests should the nurse expect to conduct on this patient to confirm this suspicion?
A)Anti-cyclic citrullinated peptide (Anti-CCP)
B)Anti-glomerular basement membrane (anti-GBM)
C)Actin (smooth muscle)and mitochondrial M2
D)Antineutrophilic cytoplasmic

Accepted Answer

Antineutrophilic cytoplasmic antibody (ANCA) test is a marker for autoimmune vasculitis, including Wegener's syndrome, and is commonly used to confirm the diagnosis. The other antibody tests mentioned are not specific to Wegener's syndrome.

Question 9

A patient diagnosed with coronary artery disease begins therapy with simvastatin (Zocor).Which laboratory result should the nurse monitor to determine the effectiveness of this treatment?
A)Aspartate aminotransferase (AST)
B)Alkaline phosphatase (ALP)
C)Alanine aminotransferase (ALT)
D)Total cholesterol

Accepted Answer

Simvastatin is a HMG-CoA reductase inhibitor (statin) used to lower cholesterol levels, specifically LDL cholesterol. Therefore, the best laboratory result to monitor the effectiveness of the treatment would be total cholesterol levels. A reduction in total cholesterol levels indicates that the medication is effectively lowering LDL cholesterol levels and reducing the patient's risk of further coronary artery disease. AST, ALT, and ALP are liver function tests that may be ordered to monitor possible side effects of statin therapy on liver function.

Question 10

A patient has an order for a blood test for antisperm antibodies.Which condition should a nurse plan to manage if this test is positive?
A)Infertility
B)Prostate cancer
C)Prostatic hypertrophy
D)Testicular cancer

Accepted Answer

A positive test for antisperm antibodies indicates that the patient's immune system is producing antibodies against their own sperm. This can lead to infertility, as the antibodies can interfere with sperm function and cause damage to the sperm. Management would involve referral to a fertility specialist for further evaluation and possible treatment options. The other conditions listed are not directly related to the presence of antisperm antibodies.

Question 11

A patient diagnosed with type 1 diabetes mellitus is maintained on a nighttime dose of basal insulin with short-acting insulin prior to meals three times daily.The patient has had two consecutive glycated hemoglobin A1c (Hgb A1c)results that are less than 5%.Which question should a nurse ask when interpreting these results?
A)"Do you experience excessive fatigue during the daytime?"
B)"Have you noticed episodes of shakiness and profuse perspiration?"
C)"How often do you have to get up at night to void?"
D)"What time of day do you usually have your meals?"

Accepted Answer

Episodes of shakiness and profuse perspiration are symptoms of hypoglycemia, which could be a concern for a patient with type 1 diabetes mellitus who has Hgb A1c results less than 5%, indicating potentially frequent or severe low blood sugar levels.

Question 12

A patient with lymphadenopathy and splenomegaly is diagnosed with infectious mononucleosis.The patient's platelet count is 50,000 per mm³.As a result of this laboratory value, a nurse should instruct the patient to: A)Avoid contact sports, vigorous exercise, and lifting heavy objects. B)Brush teeth vigorously at least twice daily to maintain good oral hygiene. C)Restrict use of fiber in the diet or bulk-forming laxatives. D)Use aspirin or NSAIDs to manage pain.

Accepted Answer

A platelet count of 50,000 per mm³ indicates thrombocytopenia, or a low platelet count, which increases the risk of bleeding. Contact sports, vigorous exercise, and lifting heavy objects can increase the risk of bleeding and should be avoided to prevent injury. Brushing teeth vigorously and restricting fiber in the diet are not related to thrombocytopenia. Aspirin or NSAIDs should not be used to manage pain in infectious mononucleosis, as they can increase the risk of bleeding.

Question 13

A patient maintained on furosemide (Lasix)is admitted with a serum potassium level of 2.9 mEq/L.Which clinical manifestation should the nurse expect to find on assessment?
A)Headache, muscle spasm, and weight gain
B)Muscle weakness, lethargy, and irregular heartbeat
C)Postural hypotension, thirst, and increased blood pressure
D)Twitching, cramping pain, and diarrhea

Accepted Answer

A serum potassium level of 2.9 mEq/L is considered hypokalemia which can cause muscle weakness, lethargy and irregular heartbeat. Other manifestations of hypokalemia include nausea, vomiting, polyuria, polydipsia, and constipation but they are not listed as options in the question. Therefore, option B is the best choice.

Question 14

A patient who is receiving chemotherapy has a white blood cell count of 7,200 cells/mm³ and a platelet count of 66.2 *10³/mm³.Which order should the nurse question for this patient? A)Acetaminophen 650 mg by mouth every 4 hours as needed for pain B)Docusate (Colace)1 to 2 tablets as needed C)Eszopiclone (Lunesta)2 mg by mouth at bedtime as needed D)Pneumococcal vaccine polyvalent (Pneumovax)0.5 mL intramuscularly

Accepted Answer

The patient is immunocompromised due to chemotherapy and is at risk for infections. Administration of vaccines is contraindicated during chemotherapy as the immune response may be weakened, and the vaccine may be less effective. Therefore, the nurse should question the order for Pneumococcal vaccine polyvalent. The other orders are appropriate for the patient's condition and should not be questioned.

Question 15

A patient diagnosed with chronic obstructive pulmonary disease (COPD)has a carboxyhemoglobin level of 5%.When planning care for this patient, which question should a nurse ask to determine the significance of this result?
A)"Do you experience a headaches or dizziness?"
B)"How many cigarettes do you smoke each day?
C)"How often do you exercise outdoors?"
D)"What kind of heating do you have in your home?"

Accepted Answer

Carboxyhemoglobin levels can be elevated in smokers due to carbon monoxide exposure from cigarette smoke. Asking about smoking habits helps assess the significance of the elevated level.

Question 16

A patient with a history of sickle cell disease has a total bilirubin level of 0.9 mg/dL with a direct bilirubin level of 0.3 mg/dL.Which additional data should the nurse obtain to plan care for this patient?
A)None, these results are normal.
B)Ultrasound of the gallbladder
C)Liver function tests
D)Serum electrolytes

Accepted Answer

The total bilirubin level of 0.9 mg/dL and a direct bilirubin level of 0.3 mg/dL are within normal ranges, indicating there is no immediate concern related to bilirubin levels that would necessitate further testing specifically for sickle cell disease management in this context.

Question 17

A patient is suspected of having biliary cirrhosis.Which of the following antibody tests should the nurse expect to conduct on this patient to confirm this suspicion?
A)Anti-cyclic citrullinated peptide (anti-CCP)
B)Anti-glomerular basement membrane (anti-GBM)
C)Actin (smooth muscle)and mitochondrial M2
D)Antineutrophilic cytoplasmic

Accepted Answer

Actin (smooth muscle) and mitochondrial M2 antibody tests are specific tests for biliary cirrhosis. Anti-CCP, anti-GBM, and antineutrophilic cytoplasmic antibodies are associated with other autoimmune diseases.

Question 18

A patient who is treated in an emergency department following a sexual assault is concerned about the possibility of infection with HIV.The patient requests a blood test to determine if HIV infection has occurred.The results are negative.Which action by the nurse is appropriate?
A)Inform the patient to monitor for symptoms, since false-negative results are common.
B)Instruct the patient to schedule a follow-up test in 6 months.
C)Reassure the patient that no infection with HIV has occurred.
D)Reinforce the need to use appropriate protection with intercourse in the future.

Accepted Answer

HIV antibodies may not be detectable immediately after exposure. A follow-up test in 6 months is recommended to confirm the initial negative result.

Question 19

A high school student is undergoing a required annual sports physical screening examination.A nurse notes that the student's serum creatinine level is 1.3 mg/dL.Which additional laboratory data should the nurse consider in order to assess the significance of this result?
A)Albumin level
B)Blood urea nitrogen
C)Hemoglobin level
D)Triglyceride level

Accepted Answer

A serum creatinine level of 1.3 mg/dL is slightly elevated and may indicate impaired renal function, so it is important to consider the blood urea nitrogen level to assess kidney function. The other laboratory values listed are not directly related to kidney function.

Question 20

A nurse is assisting with a gastrointestinal (GI)blood loss scan of a 1-month-old to detect areas of active GI bleeding.Given this patient's age, the nurse should most suspect which of the following as the cause of the bleeding?
A)Ingested foreign body
B)Allergies to milk proteins
C)Ulcers produced by nonsteroidal anti-inflammatory drug (NSAID)use
D)Mallory-Weiss tears

Accepted Answer

Allergies to milk proteins are a common cause of gastrointestinal issues in infants, including bleeding. Infants are unlikely to have ingested a foreign body due to their limited mobility and diet, NSAID use is rare in this age group, and Mallory-Weiss tears are typically associated with severe vomiting, which is less common in 1-month-old infants.

Quiz 1: About This Book

When reviewing the laboratory results for an adult patient with elevated parathyroid hormone (PTH) , which other laboratory result should the nurse interpret as significant?

A patient's laboratory test results indicate a negative finding on an infectious mononucleosis screen.The health-care provider, however, is concerned that this result could be a false-negative due to an interfering factor.Which of the following could cause such a false-negative finding?

A patient diagnosed with hepatitis B reports easy bruising and bleeding with minor skin trauma.Which lab result should a nurse relate to this finding?

The results of a patient's adrenocorticotropic hormone (ACTH) test show a decreased cortisol level and an increased ACTH level.Which of the following conditions do these results most likely indicate?

A patient with a serum phosphate level of 1.1 mg/dL is receiving IV sodium phosphate.When administering sodium phosphate, a nurse should monitor closely for:

A nurse assessing a patient with a history of inflammatory bowel disease notes bilateral pitting edema of both the ankles and feet.Which laboratory result is most likely related to this finding?

A patient who is maintained on total parenteral nutrition (TPN) due to an exacerbation of inflammatory bowel disease has a ceruloplasmin level of 17 mg/dL.For which clinical manifestation should a nurse assess this patient?

A patient is suspected of having Wegener's syndrome.Which of the following antibody tests should the nurse expect to conduct on this patient to confirm this suspicion?

A patient diagnosed with coronary artery disease begins therapy with simvastatin (Zocor) .Which laboratory result should the nurse monitor to determine the effectiveness of this treatment?

A patient has an order for a blood test for antisperm antibodies.Which condition should a nurse plan to manage if this test is positive?

A patient with lymphadenopathy and splenomegaly is diagnosed with infectious mononucleosis.The patient's platelet count is 50,000 per mm³.As a result of this laboratory value, a nurse should instruct the patient to:

A patient maintained on furosemide (Lasix) is admitted with a serum potassium level of 2.9 mEq/L.Which clinical manifestation should the nurse expect to find on assessment?

A patient who is receiving chemotherapy has a white blood cell count of 7,200 cells/mm³ and a platelet count of 66.2 *10³/mm³.Which order should the nurse question for this patient?

A patient diagnosed with chronic obstructive pulmonary disease (COPD) has a carboxyhemoglobin level of 5%.When planning care for this patient, which question should a nurse ask to determine the significance of this result?

A patient with a history of sickle cell disease has a total bilirubin level of 0.9 mg/dL with a direct bilirubin level of 0.3 mg/dL.Which additional data should the nurse obtain to plan care for this patient?

A patient is suspected of having biliary cirrhosis.Which of the following antibody tests should the nurse expect to conduct on this patient to confirm this suspicion?

A patient who is treated in an emergency department following a sexual assault is concerned about the possibility of infection with HIV.The patient requests a blood test to determine if HIV infection has occurred.The results are negative.Which action by the nurse is appropriate?

A high school student is undergoing a required annual sports physical screening examination.A nurse notes that the student's serum creatinine level is 1.3 mg/dL.Which additional laboratory data should the nurse consider in order to assess the significance of this result?

A nurse is assisting with a gastrointestinal (GI) blood loss scan of a 1-month-old to detect areas of active GI bleeding.Given this patient's age, the nurse should most suspect which of the following as the cause of the bleeding?