75-year-old who lives alone, is admitted to the hospital because of weakness and confusion.

Physical Examination

Confusion, slow to respond to questioning, generalized weakness, decreased skin turgor, dry mucous membranes, peripheral pulses weak.

Vitals: T: 101 F, BP 90/62, HR 120 bpm and irregular, RR 24, Sp02 89% on room air.

Central Venous Pressure (CVP): 1 mmHg

Pulmonary Arterial Wedge Pressure (PAWP): 2 mmHg.

Test Name

Results

Reference Range

WBC

12, 000

4, 000- 11, 000

Na+

149 mEq/L

135-145 mEq/L

K+

5.0 mEq/L

3.5- 5.0 mEq/L

Cl-

110 mEq/L

96-106 mEq/L

pH

7.34

7.35-7.45

PaCO2

34 mmHg

35- 45 mmHg

PaO2

78 mm Hg

80-100 mmHg

HCO3

21 mEq/L

22- 26 mEq/L

What order by the health care provider should the nurse question?

Increase 0.9% Normal Saline infusion to 250 ml/hr per protocol.

Collect blood cultures and start Vancomycin 1gm IV.

Collect UA for culture and sensitivity.

Administer Furosemide (Lasix) 20mg IV push.

Answer and Explanation

The Correct Answer is D

A. Increasing normal saline infusion is appropriate for treating dehydration and hypovolemia.

B. Collecting blood cultures and administering antibiotics is appropriate for treating possible sepsis, given the fever and elevated WBC count.

C. Collecting a urine sample for culture and sensitivity is appropriate to investigate a potential urinary source of infection.

D. Administering furosemide, a diuretic, is inappropriate in a client with signs of dehydration and hypovolemia (e.g., low CVP and PAWP) as it can worsen fluid depletion.

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Correct Answer is C

Explanation

A. Mild hyponatremia (Sodium < 135 mEq/L) typically does not produce distinctive ECG changes. This value is unlikely to correlate with the presence of U waves.

B. Hyperkalemia (Potassium > 5.0 mEq/L) is associated with peaked T waves, widened QRS complexes, and flattened or absent P waves, not U waves.

C. Hypokalemia (Potassium < 3.5 mEq/L) is the primary cause of U waves. A potassium level of 2.1 mEq/L is significantly low and can result in ECG changes, including U waves, ST segment depression, and prolonged QT intervals. These changes reflect altered ventricular repolarization.

D. Hypermagnesemia (Magnesium > 2.5 mEq/L) can cause ECG changes such as prolonged PR and QRS intervals, bradycardia, and heart block. However, such an extreme magnesium level of 18 mEq/L would cause severe toxicity and is not associated with U waves.

A. "The client meets the criteria for the chronic asymptomatic HIV infection phase." B. "The clients CD4+ T cell count is within normal range." C. "The client meets the criteria for the acute HIV infection phase." D. "The client has developed Acquired Immunodeficiency Syndrome (AIDS)."

Correct Answer is D

Explanation

A. Chronic asymptomatic HIV infection refers to a phase with no opportunistic infections and higher CD4+ counts.

B. A CD4+ T cell count below 200 cells/μL is abnormal and diagnostic of AIDS, not within the normal range.

C. The acute HIV infection phase occurs shortly after exposure, characterized by flu-like symptoms and high viral load, not opportunistic infections.

D. The presence of Pneumocystis jiroveci pneumonia (an AIDS-defining illness) and a CD4+ T cell count below 200 cells/μL confirms a diagnosis of AIDS.

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Test Name	Results	Reference Range
WBC	12, 000	4, 000- 11, 000
Na+	149 mEq/L	135-145 mEq/L
K+	5.0 mEq/L	3.5- 5.0 mEq/L
Cl-	110 mEq/L	96-106 mEq/L
pH	7.34	7.35-7.45
PaCO2	34 mmHg	35- 45 mmHg
PaO2	78 mm Hg	80-100 mmHg
HCO3	21 mEq/L	22- 26 mEq/L

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse observes the following EKG. Which lab would the nurse correlate with this finding?

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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