A nurse reviews the laboratory results of a patient who is receiving intravenous insulin. Which would alert the nurse to intervene immediately?

Serum chloride level of 98 mEq/L (98 mmol/L)

Serum sodium level of 137 mEq/L

Serum calcium level of 8.8 mg/dL

Serum potassium level of 2.5 mEq/L (2.5 mmol/L)

Answer and Explanation

The Correct Answer is D

Choice A reason: A serum chloride level of 98 mEq/L is within the normal range (97–107 mEq/L). It does not indicate an immediate issue in a patient receiving IV insulin. Chloride levels may shift in DKA or other conditions, but this value is normal and does not require urgent intervention, as it poses no immediate risk to cardiac or metabolic function.

Choice B reason: A serum sodium level of 137 mEq/L is within the normal range (135–145 mEq/L). Sodium levels may fluctuate in hyperglycemia due to osmotic shifts, but this value is stable. It does not warrant immediate intervention in a patient on IV insulin, as it does not indicate a critical imbalance affecting neurological or cardiovascular function.

Choice C reason: A serum calcium level of 8.8 mg/dL is within the normal range (8.5–10.2 mg/dL). Calcium levels are not directly affected by IV insulin therapy, and this value does not indicate a critical issue. No immediate intervention is needed, as it does not pose a risk to neuromuscular or cardiac function in this context.

Choice D reason: A serum potassium level of 2.5 mEq/L is critically low (normal: 3.5–5.0 mEq/L). IV insulin drives potassium into cells, worsening hypokalemia, which can cause life-threatening arrhythmias, muscle weakness, or respiratory failure. Immediate intervention, such as potassium supplementation, is required to prevent cardiac complications and ensure patient safety during insulin therapy.

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Correct Answer is A

Explanation

Choice A reason: Acute chest syndrome in sickle cell disease presents with fever, tachycardia, tachypnea, and bilateral wheezes, caused by vaso-occlusion in pulmonary vasculature, infection, or fat embolism. This leads to lung injury, hypoxia, and wheezing, matching the patient’s symptoms. It’s a life-threatening complication requiring urgent oxygenation and hydration.

Choice B reason: Pulmonary edema, typically from heart failure, causes crackles, not wheezes, and is less common in sickle cell disease. The patient’s fever, tachycardia, and wheezes suggest a pulmonary vaso-occlusive process like acute chest syndrome, not fluid overload, which is not a primary feature of sickle cell complications.

Choice C reason: An asthma exacerbation could cause wheezes, but the fever and tachycardia suggest a systemic process like acute chest syndrome, common in sickle cell disease. Asthma is not typically associated with fever unless infection is present, and sickle cell patients are more prone to acute chest syndrome.

Choice D reason: Pneumocystis pneumonia, an opportunistic infection, causes fever and respiratory symptoms but typically presents with dry cough and diffuse infiltrates, not wheezes. It’s more common in immunocompromised states like HIV, not sickle cell disease. Acute chest syndrome is more likely given the patient’s history and symptom profile.

A. CPTT B. INR C. Impedance plethysmography D. D-dimer

Correct Answer is D

Explanation

Choice A reason: CPTT (likely a typo for aPTT, activated partial thromboplastin time) measures clotting time in the intrinsic pathway, used to monitor heparin therapy. It does not detect protein fragments from fibrinolysis. In DVT, aPTT is normal unless anticoagulation is involved, making it unhelpful for detecting fibrin degradation products.

Choice B reason: INR (international normalized ratio) assesses the extrinsic clotting pathway, primarily for warfarin monitoring. It does not measure fibrin degradation products like D-dimer. In DVT, INR is typically normal unless the patient is on anticoagulants, so it is not useful for confirming fibrinolysis or diagnosing DVT.

Choice C reason: Impedance plethysmography is a non-invasive test measuring blood flow changes in veins, used to detect DVT by identifying obstructions. It does not measure protein fragments or fibrinolysis products. It assesses physical blood flow, not biochemical markers, making it irrelevant for detecting fibrin degradation in DVT.

Choice D reason: D-dimer is a specific test for fibrin degradation products, elevated in DVT due to fibrinolysis of clots. A high D-dimer indicates active clot breakdown, supporting DVT diagnosis. It is sensitive but not specific, requiring imaging confirmation, but it directly addresses the question of detecting protein fragments from fibrinolysis.

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A nurse reviews the laboratory results of a patient who is receiving intravenous insulin. Which would alert the nurse to intervene immediately?

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Naxlex Comprehensive Predictor Exams

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6 °F, a heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

Correct Answer is A

Explanation

A patient has symptoms suspicious of deep vein thrombosis. Which lab test would be helpful to see if higher-than-normal amounts of protein fragments secondary to fibrinolysis are present in the blood?

Correct Answer is D

Explanation

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