The practical nurse (PN) reviews the laboratory results of an elderly female client who is one day postoperative for a right total hip replacement (THR).

Which serum value result has the greatest implication for client safety?

Reference ranges

Hemoglobin (Hgb) [12 to 16 g/dL (120 to 160 g/L)]

Potassium (K+) [3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]

Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]

Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]

Sodium 130 mEq/L.

Hemoglobin 8.9 grams/dL.

Potassium 3.4 mEq/L

Blood urea nitrogen 20 mg/dL.

Answer and Explanation

The Correct Answer is B

A.   Sodium level of 130 mEq/L is slightly below the lower limit of the reference range but might not have as immediate an impact on safety as a critically low hemoglobin level.
B.   Hemoglobin of 8.9 grams/dL is significantly below the normal range and indicates a substantial drop in red blood cells, which can lead to impaired oxygen transport and potentially severe postoperative complications like inadequate tissue perfusion and oxygenation.
C.   Potassium level of 3.4 mEq/L is slightly below the lower limit of the reference range but might not pose an immediate threat compared to a critically low hemoglobin level.
D.   Blood urea nitrogen (BUN) of 20 mg/dL is at the upper limit of the reference range but might not have an immediate implication for client safety compared to a critically low hemoglobin level.

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Correct Answer is D

Explanation

A. Ask about pain. This is not the most important action because pain is not the primary problem in this situation. Pain may or may not be present, but it does not address the underlying cause of cyanosis.

B. Provide mouth care. This is not the most important action because mouth care does not improve oxygenation. Mouth care may be helpful to prevent infection and promote comfort, but it is not a priority in this case.

C. Offer fluids. This is not the most important action because fluids do not increase oxygen levels in the blood. Fluids may be beneficial to prevent dehydration and maintain circulation, but they are not urgent in this scenario.

D. Administer oxygen. This is the most important action because oxygen is essential for cellular function and survival. Oxygen therapy can reverse hypoxia and improve the client's condition.

A. Hyperinsulinemia. B. Ventral septal defect. C. Hypothyroidism. D. Patent ductus arteriosus.

Correct Answer is A

Explanation

A. Grunting and sternal retractions in a newborn of a mother with poorly controlled diabetes could indicate hyperinsulinemia, where the baby is experiencing hypoglycemia due to high insulin levels passed from the mother during gestation.
B. Ventral septal defect (VSD) is a congenital heart defect that typically doesn't present with grunting and sternal retractions.
C. Hypothyroidism is unlikely to cause grunting and sternal retractions in a newborn and usually manifests differently.
D. Patent ductus arteriosus (PDA) is a heart condition in newborns that might present with other signs such as a heart murmur but is not typically associated with grunting and sternal retractions.

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Naxlex Comprehensive Predictor Exams

The practical nurse (PN) observes a client's mouth and lips as seen in the picture. Which follow-up action is most important for the PN to take?

Correct Answer is D

Explanation

The practical nurse (PN) is caring for a newborn whose mother has poorly controlled type 1 diabetes mellitus and observes the newborn is grunting with mild sternal retractions. The PN should recognize the newborn is exhibiting signs of which condition?

Correct Answer is A

Explanation

The practical nurse (PN) is administering a saline enema to a client who was admitted because of a fever of unknown origin and is now constipated. Which techniques should the PN use? (Select all that apply.)

A female client with immune thrombocytopenic purpura (ITP) is transferred to a long-term care facility for physical rehabilitation. To prevent injury, which action is most important for the practical nurse to implement?

During the first trimester of pregnancy, a client who was treated for genital herpes with acyclovir prior to this pregnancy tells the practical nurse (PN) that she is experiencing an episode of genital herpes. Which nursing intervention has the highest priority?

A child diagnosed with strep throat 3 days ago enters the clinic crying hysterically. The parent tells the practical nurse (PN) that the child screams in pain even with a light touch. The child is short of breath and anxious. Which manifestations warrant immediate intervention by the PN?

What is most important for the practical nurse (PN) to include when performing pain assessment after giving an analgesic?

The practical nurse (PN) is reviewing instructions for the use of pilocarpine eye drops with a client who has glaucoma. The client states, "I should use these drops to anesthetize my eye if I experience eye pain." Which action should the PN implement?

A female client is scheduled to begin chemotherapy for breast cancer. She tells the practical nurse (PN) that the healthcare provider explained that her hair is likely to fall out as a result of the treatment. The client asks the PN if her hair will grow back. Which response is best for the

The practical nurse (PN) observes two unlicensed assistive personnel (UAP) turning an older client who had a hip arthroplasty with prosthesis placement four hours ago. Which observation by the PN indicates that the UAPS needs additional information about the turning procedure?