A nurse is caring for several clients at risk for shock. Which laboratory value requires the nurse to communicate with the primary health care provider?
Lactate: 5.4 mg/dL
White blood cell count: 11,000/mm³ (11x 10 /U)
Sodium: 150 mEq/L (150 mmol/L)
Creatinine: 0.9 mg/dL
The Correct Answer is A
A. Lactate: 5.4 mg/dL: An elevated lactate level indicates tissue hypoperfusion and anaerobic metabolism, which are early markers of shock and poor oxygen delivery. A lactate above 4 mg/dL suggests severe hypoxia or sepsis-related shock and requires immediate notification of the healthcare provider for prompt intervention and hemodynamic support.
B. White blood cell count: 11,000/mm³ (11 × 10³/µL): A mildly elevated WBC count may indicate an inflammatory or infectious process but is not immediately critical. It should be monitored, but it does not alone signal acute tissue hypoperfusion or imminent shock unless accompanied by other abnormal findings.
C. Sodium: 150 mEq/L (150 mmol/L): This indicates mild hypernatremia, which may result from dehydration or fluid loss. Although it warrants correction, it is not an urgent indicator of shock. The focus would be on assessing fluid balance and adjusting IV therapy as needed.
D. Creatinine: 0.9 mg/dL: This is within normal range and reflects adequate renal perfusion. Stable creatinine levels indicate that the kidneys are still being adequately supplied with blood, suggesting no immediate compromise in circulatory function at this time.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Dyspepsia: Dyspepsia, or indigestion, is a common symptom associated with peptic ulcer disease rather than a complication. It often presents as epigastric discomfort, bloating, or nausea, which are expected findings in this condition and not indicative of worsening disease.
B. Upper gastrointestinal (GI) bleeding: Upper GI bleeding is the most significant and potentially life-threatening complication of peptic ulcer disease. It occurs when an ulcer erodes into a blood vessel, leading to hematemesis or melena.
C. Gastric cancer: Chronic peptic ulcer disease, especially those related to H. pylori infection, can increase the long-term risk of gastric cancer. However, cancer is a delayed sequela rather than an acute complication, so it is not the immediate priority for monitoring during hospitalization.
D. Large bowel obstruction: Large bowel obstruction is unrelated to peptic ulcer disease, as ulcers occur in the stomach or duodenum, not the large intestine. Monitoring for obstruction symptoms such as abdominal distention or absence of bowel movements would not be relevant to this client’s current diagnosis.
Correct Answer is A
Explanation
A. Client with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes: Hypomagnesemia (normal 1.5–2.5 mEq/L) with neuromuscular excitability, tremors, and hyperactive reflexes can progress to life-threatening complications such as seizures or cardiac dysrhythmias. This client requires immediate assessment and intervention.
B. Client with serum sodium level of 145 mEq/L who has a dry mouth and is asking for a glass of water: Mild hypernatremia with thirst is concerning but not immediately life-threatening. The client can safely be seen after addressing more urgent neuromuscular or cardiac issues.
C. Client with serum potassium level of 5.0 mEq/L who is complaining of abdominal cramping: A potassium level of 5.0 mEq/L is at the upper limit of normal. While abdominal cramping should be monitored, there is no immediate threat of dysrhythmia at this level.
D. Client with serum phosphorus level of 4.5 mg/dL: This phosphorus level is within normal limits (2.5–4.5 mg/dL). No acute intervention is needed, making this client the lowest priority for immediate assessment.
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