The nurse is caring for a client who has been involved in a motor vehicle accident. The client's labs indicate a minimally elevated serum creatinine level. The nurse should further assess which body system for signs of injury?

• Renal

• Cardiac

• Pulmonary

• Nervous

Answer explanation

Serum creatinine is a sensitive measure of renal function. It is not an indicator of cardiac, pulmonary, or nervous system impairments.

A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

• Liver function tests (LFTs)

• Complete blood count (CBC)

• Platelet count

• Blood urea nitrogen and creatinine

Answer explanation

Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.

Which is a key diagnostic indicator of heart failure?

• Blood urea nitrogen (BUN)

• Creatinine

• Brain natriuretic peptide (BNP)

• Complete blood count (CBC)

Answer explanation

BNP is the key diagnostic indicator of HF. High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of heart failure. BUN, creatinine, and a CBC are included in the initial workup.

A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient's complete blood count (CBC), the nurse will expect which of the following CBC results?

• An increased hemoglobin and hematocrit

• A decreased hemoglobin and hematocrit

• A decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH)

• An increased MCV and MCH

Answer explanation

The decreased production of erythropoietin will result in a decreased hemoglobin and hematocrit. The patient will have normal MCV and MCH values.

The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

• “I feel hot all of the time.”

• “I have a difficult time falling asleep at night.”

• “I have an increase in my appetite.”

• “I have difficulty breathing when walking 30 feet.”

Answer explanation

Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. The client would feel cold and not hot. The client is fatigued and able to sleep often with a decrease in appetite, not an increase.

A nursing instructor is evaluating a student caring for a neutropenic client. The instructor concludes that the nursing student demonstrates accurate knowledge of neutropenia based on which intervention?

• Monitoring the client’s temperature and reviewing the client’s complete blood count (CBC) with differential

• Monitoring the client’s breathing and reviewing the client’s arterial blood gases

• Monitoring the client’s heart rate and reviewing the client’s hemoglobin

• Monitoring the client’s blood pressure and reviewing the client’s hematocrit

Answer explanation

Clients with neutropenia often do not exhibit classic signs of infection. Fever is the most common indicator of infection, yet it is not always present. No definite symptoms of neutropenia appear until the client develops an infection. A routine CBC with differential can reveal neutropenia before the onset of infection.

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order?

• CBC

• antibiotic

• chest radiograph

• ECG

Answer explanation

Most clients with iron-deficiency anemia have reduced energy, feel cold all the time, and experience fatigue and dyspnea with minor physical exertion. The heart rate usually is rapid even at rest. The CBC and hemoglobin, hematocrit, and serum iron levels are decreased. A CBC would be ordered.

A 20-year-old client cut a hand while replacing a window. While reviewing the complete blood count (CBC) with differential, the nurse would expect which cell type to be elevated first in an attempt to prevent infection in the client’s hand?

• Eosinophils

• Neutrophils

• B cells

• Monocytes

Answer explanation

Neutrophils (polymorphonuclear leukocytes [PMNs]) are the first cells to arrive at the site where inflammation occurs. Eosinophils and basophils, other types of granulocytes, increase in number during allergic reactions and stress responses.

The nurse cares for a client prescribed warfarin orally. The nurse reviews the client’s prothrombin time (PT) level to evaluate the effectiveness of the medication. Which laboratory values should the nurse also evaluate?

• international normalized ratio (INR)

• partial thromboplastic time (PTT)

• complete blood count (CBC)

• Sodium

Answer explanation

The INR, reported with the PT, provides a standard method for reporting PT levels and eliminates the variation of PT results from different laboratories. The INR, rather than the PT alone, is used to monitor the effectiveness of warfarin. The therapeutic range for INR is 2 to 3.5, although specific ranges vary based on diagnosis. The other laboratory values are not used to evaluate the effectiveness of warfarin.

A client is taking hydroxyurea as treatment for essential thrombocythemia. Which laboratory test will the nurse remind the client to have completed regularly?

• Uric acid level

• Clotting factors

• Complete blood count

• Serum potassium level

Answer explanation

Clients taking hydroxyurea should have the CBC monitored regularly because the dosage is adjusted based on the platelet and WBC count. Uric acid, clotting factors, and serum potassium level do not need to be monitored when taking hydroxyurea.