The nurse is reviewing pre-operative laboratory studies of an adult client on a medical-surgical unit. Which result should be reported to the physician immediately?
Sodium, 152 mEq/L
Potassium, 3.8 mEq/L
Calcium, 10.0 mg/dL
Creatinine, 1.2 mg/dL
The Correct Answer is A
Choice A Reason:
Sodium levels in the blood should normally be between 135 and 145 mEq/L. A level of 152 mEq/L is considered high and can be indicative of hypernatremia, which requires prompt medical attention to address potential dehydration, kidney issues, or other underlying conditions.
Choice B Reason:
Potassium levels should be within the range of 3.5 to 5.2 mEq/L for adults. A result of 3.8 mEq/L falls within the normal range, indicating no immediate concern regarding potassium levels.
Choice C Reason:
Calcium levels in the blood are typically between 8.6 and 10.2 mg/dL for adults. Therefore, a calcium level of 10.0 mg/dL is within the normal range and does not require urgent reporting to a physician.
Choice D Reason:
Creatinine levels in the blood should be between 0.6 to 1.3 mg/dL in adults, depending on factors such as age, gender, and muscle mass. A level of 1.2 mg/dL is at the higher end of the normal range but is not typically considered critical unless there are other signs of kidney dysfunction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason
Monitoring for hypoglycemia at 1200 is not optimal because it is well past the peak action time of insulin aspart, which occurs approximately 45–90 minutes after administration. By noon, the insulin's effects are waning, and the risk of hypoglycemia is lower compared to the peak action period.
Choice B Reason
Monitoring at 1000 might still catch the tail end of the peak action time, but it is not the most likely time for hypoglycemia to occur. The nurse could miss the initial signs of hypoglycemia if monitoring starts two hours after administration.
Choice C Reason
0900 is the most appropriate time for the nurse to monitor for hypoglycemia. Insulin aspart has a rapid onset of action, peaking in about 45–90 minutes, and the effects last for 3–5 hours. Monitoring one hour after administration aligns with the start of the peak action time, when hypoglycemia is most likely to occur.
Choice D Reason
Monitoring at 1100 is less ideal because it is nearing the end of the peak action period. While there is still a risk for hypoglycemia, the highest risk would have been earlier, closer to the peak action time.
Correct Answer is A
Explanation
Choice a reason:
Risperidone is an antipsychotic medication that can help manage both positive symptoms (such as delusions and hallucinations) and negative symptoms (such as apathy and social isolation) of schizophrenia. Monitoring both types of symptoms is essential to evaluate the overall effectiveness of the treatment. Positive symptoms are often more responsive to medication, while negative symptoms can be more challenging to treat and may require a comprehensive approach including psychosocial interventions.
Choice b reason:
Disorganized symptoms, which include disorganized speech and behavior, are another aspect of schizophrenia that can be impacted by risperidone. While these symptoms are not mentioned in the client's current presentation, they are still important to monitor as part of a comprehensive assessment of the client's condition.
Choice c reason:
Negative symptoms like apathy and social isolation can significantly impact a client's quality of life and functional abilities. Risperidone can help improve these symptoms, but they often require longer treatment duration and additional supportive therapies for significant improvement.
Choice d reason:
Positive symptoms such as delusions and hallucinations are critical targets for risperidone treatment. These symptoms can be distressing and disruptive, and their improvement is a key indicator of the medication's effectiveness. Monitoring the reduction or resolution of these symptoms is crucial for assessing the client's response to risperidone.
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