A nurse is reviewing labs on an unconscious client who arrived to the emergency room. Which abnormal lab value would make the nurse suspect a traumatic crush injury?

Sodium 140 mEq/L

Calcium 9.0 mEq/L

Arterial pH 7.38

Potassium 7.2 mEq/L

Answer and Explanation

The Correct Answer is D

Choice A reason: A sodium level of 140 mEq/L is perfectly within the normal reference range (135 to 145 mEq/L). It does not provide any diagnostic clues regarding a traumatic crush injury or the subsequent cellular destruction associated with rhabdomyolysis.

Choice B reason: A calcium level of 9.0 mg/dL is within the normal reference range (8.5 to 10.5 mg/dL). In a severe crush injury, one would more likely expect to see hypocalcemia in the early stages as calcium binds to damaged muscle tissues, followed by hypercalcemia later.

Choice C reason: An arterial pH of 7.38 is within the normal physiological range (7.35 to 7.45). Significant crush injuries typically result in metabolic acidosis (a low pH) due to the release of lactic acid and other organic acids from ischemic and necrotic muscle tissues.

Choice D reason: Potassium is the primary intracellular cation. When muscle cells are crushed and destroyed (rhabdomyolysis), massive amounts of potassium are released into the extracellular fluid. A level of 7.2 mEq/L is a critically high value that is highly characteristic of the cell lysis associated with traumatic crush injuries.

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Correct Answer is C

Explanation

Choice A reason: A heart rate of 115 beats per minute is expected in hypovolemic shock as a compensatory response to low stroke volume. While the nurse should monitor this to ensure it trends downward with fluid administration, it does not indicate a new, acute complication of the treatment itself.

Choice B reason: Anxiety and restlessness are common signs of early shock due to decreased cerebral perfusion and increased sympathetic nervous system activity. These symptoms should improve with successful fluid resuscitation and are not typically a reason to stop or immediately change the infusion.

Choice C reason: The presence of new crackles in the lungs indicates fluid moving into the alveoli, a sign of pulmonary edema or fluid volume overload. This suggests the fluid resuscitation is exceeding the heart's ability to pump, requiring the nurse to immediately slow the infusion and notify the provider.

Choice D reason: A urinary output of 35 mL/hr is a positive finding in a patient being treated for shock, as it exceeds the minimum requirement of 30 mL/hr. This indicates that the fluid resuscitation is successfully improving renal perfusion and should be continued as ordered.

A. Decreased temperature B. Increased blood pressure C. Increased urine output D. Decreased heart rate

Correct Answer is C

Explanation

Choice A reason: While a fever may be present in some cases of rhabdomyolysis due to systemic inflammation, a decrease in temperature is not the primary clinical indicator used to measure the effectiveness of the specific treatment for myoglobinuria or renal protection.

Choice B reason: Increased blood pressure might occur as a result of fluid resuscitation, but it is not the specific goal for treating rhabdomyolysis. Blood pressure is a general indicator of hemodynamic status rather than a specific measure of whether myoglobin is being cleared from the kidneys.

Choice C reason: In rhabdomyolysis, large amounts of myoglobin are released into the bloodstream, which can obstruct renal tubules and cause acute tubular necrosis. The goal of aggressive IV fluid therapy is to "flush" the kidneys. Increased urine output confirms that the myoglobin is being diluted and excreted effectively.

Choice D reason: A decreased heart rate may indicate that the patient’s fluid volume is being restored and the compensatory tachycardia is resolving. However, this is a secondary sign of hemodynamic stability and does not directly confirm the prevention of myoglobin-induced renal damage.

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A nurse is reviewing labs on an unconscious client who arrived to the emergency room. Which abnormal lab value would make the nurse suspect a traumatic crush injury?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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