Question 1

You are caring for an elderly male client in a long-term care facility.As part of his annual physical examination,the nurse practitioner orders some laboratory tests,including a complete blood count,serum electrolytes,and thyroid tests.The resident's wife questions these tests stating: "He seems fine to me,a little sleepy,but he is 85 years old,you know." In explaining the rationale for these tests,you base your response on your knowledge that:
A) his wife has an excellent point; you should speak to the nurse practitioner about canceling them.
B) when conducted annually,all of the tests are helpful in promoting maximum health for older adults in the long-term care setting.
C) the tests are useful,but only if clinically indicated.
D) the complete blood count and serum electrolytes are useful screening tests,but you will question the nurse practitioner about the thyroid tests.

Accepted Answer

Laboratory tests are a fast and accurate way of assessing key parts of an older person's physical functioning.Option A is incorrect because the tests are useful.The laboratory tests are being used as annual screening,and therefore do not need to be clinically indicated.Excessive sleepiness is not normal in an 85-year-old and may be a sign of a thyroid disorder.

Question 2

A 77-year-old woman with breast cancer has completed a course of external radiation and is receiving chemotherapy.After her recent chemotherapy treatment,she complains of severe weakness and lethargy,and is admitted to the hospital.She has an unsteady gait,and complains of dizziness when arising from the chair.Her platelet count is 45,000.Based on this scenario,what nursing intervention is of the highest priority?
A) Preventing falls
B) Maintaining skin integrity
C) Preventing infection
D) Replacing fluids

Accepted Answer

Falls prevention is the highest priority.The patient has at least two significant risk factors for falls (unsteady gait and complaints of dizziness).She has a platelet count of 45,000; a platelet count of less than 50,000 makes one at high risk for spontaneous bleeding.The nurse must observe for overt and covert bleeding.If the patient falls,she is very likely to have a significant injury because of the low platelet count.Maintaining skin integrity would be important in this patient because she has received external radiation,which can cause alterations in skin integrity,but this is not as high a priority.Although preventing infection is an important intervention in a patient with cancer who has received radiation and chemotherapy,there is no evidence that this patient has alterations in her laboratory values related to the treatments,so falls prevention is more critical.There are no specific indications that this patient is experiencing a fluid deficit.

Question 3

You are a nurse working in a community health center that is sponsoring a program that offers free prostate-specific antigen (PSA)blood tests to all men older than age 50.A man approaches you and asks,"What is this all about?" What is the best response to him?
A) "PSA is one of the primary screening tests for prostate cancer.All men older than 50 should be screened for prostate cancer."
B) "PSA is a definitive way to diagnose prostate cancer.All men older than 50 should be screened for prostate cancer."
C) "PSA is indicated when a man has other symptoms of prostate cancer."
D) "PSA is invalid unless a digital rectal exam is done immediately before the blood sample being drawn."

Accepted Answer

PSA and a digital rectal examination are the two screening tests for prostate cancer.The risk of developing prostate cancer is 2.01% for men older than age 50 and increases significantly for men older than age 60.Screening is an important step in prevention.PSA is a screening test,not a definitive way of diagnosing the condition.PSA is indicated as a screening tool,whether or not symptoms are present.PSA is a useful screening tool alone.However,when PSA and digital rectal examination are combined,the overall value of the screens increases.It is recommended that the PSA be drawn before digital rectal examination because the examination can cause increased levels of PSA.

Question 4

While looking at your patient's laboratory values,you note the following values.Which contains an alteration (increase or decrease)that you might expect with aging?
A) Potassium 4.5 mEq/L
B) Blood urea nitrogen (BUN)10 mg/dL
C) Creatinine 0.8 mg/dL
D) Erythrocyte sedimentation rate (ESR)20 mm/hr

Accepted Answer

The ESR is slightly elevated (10 to 20 mm/hr)in healthy older adults.Options A,B,and C all remain consistent with aging.

Question 5

An 83-year-old resident of a long-term care facility has dementia.She is usually able to feed herself and perform basic ADLs with minimal assistance.She is continent of bowel and bladder,but needs assistance with toileting.The nurse aide who routinely cares for her reports to the nurse that the resident has had three episodes of urinary incontinence and has a decreased appetite.Her daughter reports that her mother seems "different" and "a bit more confused." You speak with the physician who orders a complete blood count and serum electrolytes and states "Call me if any of the labs are abnormal." The lab tests are all within normal limits.The nurse should:
A) attribute the changes in the resident's functioning to advancing dementia.The lab values are OK,so nothing acute is happening.
B) speak with the physician and suggest that the resident be placed on broad-spectrum antibiotics to prevent infections.
C) speak with the physician because,although the laboratory values are within normal limits,the changes in function (decreased appetite,change in mental status,and incontinence)may be subtle signs of illness.
D) change the plan of care to include bladder training and implement a 24-hour calorie count.

Accepted Answer

Waiting for usual signs of infection or illness in older adults can be fatal.In older adults,signs of infection may be absent or not seen until the patient is septic or very ill.The nurse needs to be alert to the subtle changes in the patient.Laboratory values do not always change in older adults,often not until the patient is very ill.Infections are not prevented by placing a patient on broad-spectrum antibiotics.This action may in fact cause bacteria to become drug resistant.All evidence points to the changes in functioning being attributable to acute illness.The nurse needs to respond to the acute illness first.

Question 6

A 69-year-old patient in the geriatric clinic has his annual physical examination,and a complete blood count and serum electrolytes are drawn.His laboratory results show an elevated blood urea nitrogen (BUN).What is the next action of the nurse?
A) Assume that the laboratory result was a false-positive because the patient did not exhibit any symptoms of renal failure.
B) Look at his medication list because an elevated BUN may be the result of specific medications.
C) Instruct him on collecting a 24-hour urine specimen for protein analysis.
D) Tell him that an elevated BUN is normal in older adults.

Accepted Answer

Protein intake affects BUN and many drugs increase the levels.An elevated BUN is not diagnostic of renal failure alone and will not necessarily be reflected in physical symptoms.Option C is not the first action that the nurse should take.An elevated BUN is not expected as a normal part of aging.Renal functioning decreases substantially with aging,but in most cases the body is able to compensate adequately with only slight increases in laboratory findings.

Question 7

What is true concerning laboratory values in older adults?
A) There are age-adjusted ranges for older adults for all of the common laboratory findings,similar to those for infants and children.
B) There are no age-adjusted ranges for older adults due to the large variations within the age group and the increasing number of factors that influence the results.
C) There are age-adjusted ranges only for the over-85 age-group; there are no expected changes in the 65- to 84-year-old age-group.
D) There are age-adjusted ranges only for the hematological tests,which are due mostly to changes in the bone marrow.

Accepted Answer

There are no age-adjusted ranges for laboratory values due to the variation within the group as well as the many chronic illnesses of older adults.Variations are more likely to be seen the older one is.Although several age-related hematological changes occur mainly from changes in the bone marrow,few are clinically significant.

Quiz 5: Laboratory Values and Diagnostics

You are a nurse working in a community health center that is sponsoring a program that offers free prostate-specific antigen (PSA) blood tests to all men older than age 50.A man approaches you and asks,"What is this all about?" What is the best response to him?

While looking at your patient's laboratory values,you note the following values.Which contains an alteration (increase or decrease) that you might expect with aging?

A 69-year-old patient in the geriatric clinic has his annual physical examination,and a complete blood count and serum electrolytes are drawn.His laboratory results show an elevated blood urea nitrogen (BUN) .What is the next action of the nurse?

What is true concerning laboratory values in older adults?