A nurse on a medical unit is reviewing the laboratory reports for a client. Which of the following laboratory values is the priority to report to the provider?

Potassium level 3 mEq/L.

BUN 9.5 mg/dl

Creatinine 0.4 mg/dl

Sodium 135 mEq/L

Answer and Explanation

The Correct Answer is A

A) Potassium level 3 mEq/L:
A potassium level of 3 mEq/L is below the normal range (which is typically 3.5-5.0 mEq/L) and represents hypokalemia. Potassium is crucial for normal muscle and nerve function, including cardiac function. Low potassium levels can lead to dangerous arrhythmias, muscle weakness, and cardiac arrest if not addressed promptly. This is the priority value because hypokalemia can be life-threatening and requires immediate attention from the healthcare provider to correct the imbalance.

B) BUN 9.5 mg/dl:
A BUN (blood urea nitrogen) level of 9.5 mg/dL is within the normal reference range for most adults (typically 7-20 mg/dL). While an abnormal BUN level could indicate kidney dysfunction or dehydration, this value is not immediately concerning and does not represent a critical finding that requires urgent attention.

C) Creatinine 0.4 mg/dl:
A creatinine level of 0.4 mg/dL is below the normal range (usually around 0.6-1.2 mg/dL), which might indicate low muscle mass or a transient decrease in kidney function. However, a low creatinine level is generally not as urgent or concerning as an elevated level, and it does not typically require immediate intervention

D) Sodium 135 mEq/L:
A sodium level of 135 mEq/L is slightly below the normal range (135-145 mEq/L), indicating mild hyponatremia. Although this can be concerning if the drop is acute or symptomatic (e.g., causing confusion, seizures, or lethargy), a mild decrease in sodium is not immediately life-threatening unless it worsens rapidly.

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Correct Answer is B

Explanation

A) Assessment:
Assessment involves gathering and analyzing data about the client’s health status and needs. While gathering information from the social worker and physical therapist may be part of the assessment process, the actual collaborative work in preparing the discharge plan is more aligned with the planning phase of the nursing process.

B) Planning:
Planning is the correct answer because it involves formulating goals, interventions, and expected outcomes for the client’s care, including discharge projections. In this case, the nurse, social worker, and physical therapist are working together to develop a comprehensive discharge plan tailored to the client’s needs, which is a key part of the planning phase.

C) Evaluation:
Evaluation occurs after interventions are implemented to assess whether the goals have been met and the outcomes achieved. Since the nurse is still in the process of preparing the discharge plan, evaluation has not yet occurred.

D) Analysis:
Analysis is the process of interpreting assessment data to identify problems or needs. While analysis is part of the assessment phase, it does not describe the collaborative action of creating a discharge plan, which is clearly a planning task.

A. Describe the steps of walking with crutches for the client B. Encourage the client to ask questions about walking with crutches C. Show the client a video on walking with crutches D. Ask the client to demonstrate walking with crutches

Correct Answer is D

Explanation

A) Describe the steps of walking with crutches for the client:
Describing the steps of walking with crutches involves cognitive learning, where the focus is on understanding and acquiring knowledge. In this case, the nurse is providing verbal information to the client about how to use crutches, but this does not engage the psychomotor domain, which involves the physical performance of tasks or skills.

B) Encourage the client to ask questions about walking with crutches:
Encouraging questions is part of the affective domain of learning, which focuses on attitudes, feelings, and the ability to value or appreciate information. By encouraging the client to ask questions, the nurse is promoting understanding and engagement, but this is not related to the psychomotor domain, which requires physical action or skill development.

C) Show the client a video on walking with crutches:
Showing a video involves cognitive learning as it provides the client with visual information and demonstrations. While this helps with understanding how to walk with crutches, it is still a passive form of learning where the client is watching but not physically engaging with the task.

D) Ask the client to demonstrate walking with crutches:
Asking the client to demonstrate walking with crutches directly involves the psychomotor domain of learning, which is concerned with the physical act of performing tasks or skills. By demonstrating how to walk with crutches, the client is actively engaging in the skill, allowing for hands-on practice and the development of muscle memory.

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A nurse on a medical unit is reviewing the laboratory reports for a client. Which of the following laboratory values is the priority to report to the provider?

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