Comprehensive Guide to Common Medical Laboratory Values and Interpretations, Exams of Nursing

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Adv. Med Surg 480

(West Coast

University) Based on

ATI 90 questions

with all correct

answers latest

solution

solution pH - correct answer 7.35 - 7. PaCO2 - correct answer 35 - 45 HCO3 - correct answer 22 - 26 PaO2 - correct answer 80 - 100 SaO2 - correct answer 95%-100% RBC - correct answer Male: 4.7 - 6. Female: 4.2 - 5. Elevated level: erythrocytosis, polycythemia vera, severe dehydration Decreased level: anemia, hemorrhage, kidney disease Hgb - correct answer Males: 14 to 18 g/dL Females: 12 to 16 g/dL Elderly: levels slightly decreased Elevated level: erythrocytosis, COPD, severe dehydration Decreased level: anemia, hemorrhage, kidney disease Hct - correct answer Males: 42 to 52% Females: 37 to 47% Elderly: levels slightly decreased Elevated level: erythrocytosis, COPD, severe dehydration Decreased level: anemia, hemorrhage, kidney disease MCV - correct answer 80 to 95 fL Elevated level: macrocytic (large) RBCs, megaloblastic anemia. Decreased level microcytic (small) RBCs, iron deficiency anemia. MCH - correct answer 27 to 31 pg/cell Elevated level: macrocytic (large) RBCs, megaloblastic anemia. Decreased level microcytic (small) RBCs, iron deficiency anemia.

solution TIBC - correct answer 250 to 460 mcg/dL Elevated level: iron deficiency anemia, polycythemia vera Decreased level: malnutrition, cirrhosis, pernicious anemia WBC - correct answer 5,000 to 10,000/mm Elevated level: infection, inflammation. Decreased level: immunosuppression, autoimmune disease WBC differential % - correct answer Neutrophils 55-70% Lymphocytes 20-40% Monocytes 2-8% Eosinophils 1-4% Basophils 0.5-1% Platelets - correct answer 150,000 to 400,000 mm Increased level: malignancy, polycythemia vera, rheumatoid arthritis. Decreased level: enlarged spleen, hemorrhage, leukemia INR (desired goal of 2 to 3 on warfarin therapy) - correct answer 0.8 to 1. Measures the mean of PT to provide a universally recognized value. Elevated level: warfarin therapy Decreased level: cancer disorders PT (prothrombin time) - correct answer 11.0-12.5 sec (how long it takes for blood to clot) Increased time: of clotting factors II, V, VII, or X, liver disease, warfarin therapy, disseminated intravascular coagulation Decreased time: vitamin K excess, pulmonary embolus, thrombophlebitis aPTT (1.5 to 2.5 times the control value if receiving heparin therapy) - correct answer 30 to 40 seconds

solution Increased time: vitamin K deficiency, disseminated intravascular coagulation (DIC), liver disease, heparin administration Decreased time: extensive cancer D-dimer - correct answer Less than 0.4 mcg/mL Positive result: disseminated intravascular coagulation, malignancy Negative result: can rule out pulmonary embolus or deep vein thrombosis Fibrinogen - correct answer 200 to 400 mg/dL Elevated level: acute inflammation, acute infection, heart disease Decreased levels: liver disease, advanced cancer, malnutrition Fibrin degradation - correct answer Less than 10 mcg/mL Elevated level: disseminated intravascular coagulation, massive trauma resulting in fibrinolysis Decreased level: anticoagulation therapy ALT - correct answer 4 to 36 units/L Elevation occurs with hepatitis or cirrhosis AST - correct answer 0 to 35 units/L Elevation occurs with hepatitis or cirrhosis ALP - correct answer 30 to 120 units/L Elevation indicates liver damage. Amylase - correct answer 30 to 220 units/L

solution Elevation occurs with pancreatitis. Lipase - correct answer Lipase 0 to 160 units/L Elevation occurs with pancreatitis. Total bilirubin - correct answer 0.3 to 1 mg/dL Elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder. Direct (conjugated) bilirubin - correct answer 0.1 to 0.3 mg/dL Elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder. Indirect (unconjugated) bilirubin - correct answer 0.1 to 0.3 mg/dL Elevations indicate altered liver function, bile duct obstruction, or other hepatobiliary disorder. Albumin - correct answer 3.5 to 5 g/dL Decrease can indicate hepatic disease. Alpha-fetoprotein - correct answer Less than 40 mcg/L Elevated in liver cancer, cirrhosis, hepatitis. Ammonia - correct answer 10 to 80 mcg/dL Elevated in liver disease GFR - correct answer 90 - 125 ml/min BUN - correct answer 10 - 20 mg/dL Digoxin (Lanoxin) Critical Level (Toxicity) - correct answer >2. Creatinine - correct answer ● Expected reference range, females 0.5 to 1.1 mg/dL ● Expected reference range, males 0.6 to 1.2 mg/dL

solution Can increase due to deteriorating kidney function, which can occur as a result of advanced liver disease Fasting Blood Glucose - correct answer <110 mg/dL Oral Glucose Tolerance Test - correct answer <140 mg/dL Na++ - correct answer 136 - 145 mEq/L K+ - correct answer 3.5 - 5. Calcium - correct answer 8.6 - 10 mg/dl Cl- - correct answer 98 - 106 Mg - correct answer 1.3 - 2.1 mEq/L Urine Spec Gravity - correct answer 1.010 - 1. Central Venous Pressure (CVP) - correct answer 1 to 8 mmHg Serum ADH - correct answer 1 - 5 pg/mL Pulmonary artery wedge pressure (PAWP) - correct answer 4 to 12 mmHg Cardiac output (CO) - correct answer 4 to 7 L/min Cholesterol (total) - correct answer Expected < 200 mg/dL HDL - correct answer You want HDL high Males: 35 to 65 mg/dL Females: 35 to 80 mg/dL LDL - correct answer You want LDL low Expected <130 mg/dL Triglycerides - correct answer Males: 40 to 160 mg/dL Females: 35 to 135 mg/dL Adults over age 65: 55 to 220 mg/dL Bradycardia <60bpm - correct answer Medication: Atropine and isoproterenol Electric: Pacemaker

solution AFib, supraventricular tachycardia (SVT), Ventricual tachycardia w/pulse - correct answer Medication: Amiodarone, adenosine, and verapamil Electric: Synchronized cardioversion Ventricular tachycardia without pulse, or VFib - correct answer Medication: Amiodarone, lidocaine, and epinephrine Electric: Defibrillation Side effects of nitroglycerin - correct answer Headache is a common side effect. Also, weakness, dizziness, lightheadedness, nausea, and flushing as your body adjusts to this medication. MI Pt. given nitroglycerin - correct answer side effect is headache due to low BP S/S of hypoglycemia - correct answer mild shakiness, mental confusion, palpitations, headache, lack of coordination, blurred vision, seizures, and diaphoresis S/S of hyperglycemia - correct answer hot dry skin, fruity breath, blurred vision, headache, weakness, fatigue, drowsiness, polyuria, dehydration, vomiting Syndrome of inappropriate ADH (SIADH) - correct answer - fluids will be too high - sodium will go down (give sodium)

• defined as an excessive release of ADH, also known as vasopressin, secreted by the posterior lobe of the pituitary gland Syndrome of inappropriate ADH (SIADH) - correct answer - Excess ADH leads to renal reabsorption of H2O and suppression of renin angiotensin mechanism, causing renal excretion of sodium leading to water intoxication, cellular edema, and dilution hyponatremia. Fluid shifts within compartments cause decreased serum osmolarity. S/S of SIADH - correct answer headache, weakness, anorexia, muscle cramps, and weight gain Digoxin dangers and toxicity - correct answer A severe case of DT is dangerous because it can cause your heart to beat too quickly, too slowly, or irregularly. Heart failure is a significant risk and can be life-threatening. Normal levels = Digoxin: 0.8 to 2.0 ng/mL. toxicity = >2. S/S Digoxin toxicity - correct answer The main symptoms of this condition affect the stomach, breathing, and vision. Because the condition is a form of poisoning, you will likely lose your appetite and experience nausea, vomiting, and/or diarrhea. Your heart might also beat faster or slower than usual, or you might have an irregular heartbeat. Pt's may also experience confusion Digoxin and hyperkalemia - correct answer - Digoxin toxicity will increase with hyperkalemia. - When digoxin's mechanism kicks-in, then it decreases the use of K+ ions in the sodium- potassium pump by decreasing the NA-K ATPase activity. This reduction leads to a build-up of

solution potassium in the body. Dehydration and various illnesses often are also contributing factors to the change to K+ levels and hyperkalemia. Insulin: Rapid acting - correct answer Onset is rapid...10-30 min depending on the drug

• Aspart (NovoLog), - Lispro (Humalog), Glulisine (Apidra) Insulin: Short acting (Regular) - correct answer Only one you can give IV (U-100)
• Humulin R, - Novolin R *Administer 30-60 min before meals Insulin: Intermediate acting - correct answer - NPH insulin (Humulin N, Novolin R) *Administer btw meals and at night *Administer subQ only *Never mix with any other insulin Client education for insulins - correct answer - Provide info regarding self administration of insulin (rotate injection sites, inject at 90 deg, clear cloudy, cloudy clear), - Advise client to eat at regular intervals, avoid alcohol, adjust insulin to exercise, - Hypoglycemia manifestations and management, - Hyperglycemia manifestations and management Hypoglycemia manifestation and management - correct answer - teach client measures to take in response to manifestations of hypoglycemia (mild shakiness, mental confusion, sweating , palpitations, headache, lack of coordination, blurred vision, seizures and coma), - hypoglycemia preventive measures are to avoid excess insulin, exercise, and alcohol consumption on an empty stomach, - check blood glucose levels, - Guidelines (for hypo (client w/ 70mg or less) take 15 - 20 g of readily absorbable carbs, repeat if not corrected in 15 min Hyperglycemia manifestations and management - correct answer - teach client manifestations of hyper (hot, dry skin and fruity breath) and measures to take in response, - encourage oral fluid intake of sugar free fluids to prevent dehydration, - Administer insulin as prescribed, - restrict exercise when blood levels are > 250 mg/dL, - test urine for ketones (range 0.6 - 1.5), - encourage wear of a med ID wrist band, - oral hypoglycemics Coronary Artery Bypass Graft (CABG), Pt care post op - correct answer - Maintain patent airway (monitor RR, Auscultate and report crackles, Monitor SaO2, etc..). - Encourage the client to splint the incision while deep breathing and coughing. - Dangle and turn client from side to side Q2hr, - Assist client to chair within 24 hr, - Ambulate client 25 - 100 ft first post op day, - monitor pt heart rate and rhythm

solution Cardiac enzymes - correct answer - Cardiac enzymes are released into the bloodstream when the heart muscle suffers ischemia. - Cardiac enzymes are specific markers in diagnosing MI. - Myoglobin will be the first enzyme to show up on a test usually within 2 hrs Cardiac enzymes: troponin - correct answer Troponin takes time to build up and be noticed on a test, if enzyme is negative at first then admit the Pt and do enzymes Q8hrs for 24 hours Pacemaker: What happens when pacemaker malfunctions - correct answer BP will go down due to low CO....same as with premature contractions, BP will go down due to low CO Pacemaker spike - correct answer vertical signals that represent the electrical activity of the pacemaker Pacemaker: failure to capture - correct answer Electrical charge to myocardium is insufficient to produce atrial or ventricular contraction Lead damage, battery failure, dislodgement of the electrode, fibrosis at the electrode tip Pacemaker: Failure to sense - correct answer Failure to recognize spontaneous atrial or ventricular activity and pacemaker fires inappropriately Lead damage, battery failure, dislodgement of the electrode. Diabetes insipidus (DI) and its effects on electrolytes, fluids, and osmolarity - correct answer With DI there is a deficiency of ADH which causes extreme polyuria, the polyuria causes dilution of the urine which causes Na+ to go down, urine osmolarity and specific gravity will go down bc the urine is dilute, not concentrated. Treatment should be aimed at controlling the bodies fluids and treating underlying causes. Urine chemistry is diluted while serum chemistry is concentrated Angiogram - correct answer also called cardiac catheterization, is an invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage. Angiogram (cont'd) - correct answer Pt arrives at hospital with chest pain, in cath lab we look at what is going on using contrast dye...this dye can damage the kidney and also has a diuretic effect...give Pt fluids (1L) to replace fluids and wash out dye. Angiogram (Allergies) - correct answer there can be allergies to dye (shell fish, iodine)...can give Pt. antihistamine if the benefits outweigh the consequences. Diabetes care - correct answer - reduce symptoms, promote well being, prevent acute complications of hyperglycemia, and prevent or delay the onset and progression of long term complications Diabetes care (Nursing care) - correct answer - Monitor: blood glucose levels and factors affecting levels, I&O and weight, skin integrity, sensory alterations, visual alterations, dietary practices, exercise patterns, SMBG skill, self medication skill

solution Diabetes (client education) - correct answer - teach client appropriate SMBG technique, provide information on self administration of medication, rotate injection sites to prevent lipohypertrophy or lipoatrophy in one site, foot care, nutritional guidelines Pt. care following angiogram - correct answer angiocele...care for site of insertion....pt. at risk for bleeding due to heparin...assess for bleeding time (ACT and PCT)....femstop Pt. care following angiogram (cont'd) - correct answer - Assess vital signs (15min X 4, 30min X 2, Q hr X 4), Assess groin site for bleeding/hematoma and thrombosis, maintain bed rest in supine position, continuous cardiac monitoring for dysrhythmia, Administer anti platelet or thrombolytic to prevent clot formation and restenosis (Heparin), PRN ativan, I&O's and IV fluids for rehydration, removal of sheath from vessel. Atrial fib...management and meds...why we give meds - correct answer Atrial Fibrillation is characterized by a total disorganization of atrial electrical activity bc of multiple ectopic foci, resulting in loss of effective atrial contraction. During Afib, the atrial rate may be as high as 350

• 600 bpm and P waves are replaced with chaotic, fibrillatory waves. Afib results in a decrease in CO bc of ineffective atrial contraction and/or rapid ventricular response. Thrombi formation is a concern due to stasis of blood in the atria. Afib Meds/Treatment - correct answer Treatment: the goals of treatment include a decrease in ventricular response (<100bpm), prevention of stroke, and conversion to sinus rhythm. Rate control drugs: Calcium channel blockers (diltiazem), beta-adrenergic blockers (metaprolol), dronedarone and digoxin (Lanoxin) Warfarin/Afib - correct answer Warfarin is the drug of choice to treat patients with atrial fibrillation who have one or more high risk factors in order to prevent stroke. If Warfarin is considered unsuitable for the patient the addition of clopidogrel (Plavix) reduces the risk. Bleeding is a potential and serious side effect of warfarin, check INR blood levels, keep vitamin K levels down to prevent interference w/warfarin. How to manage HYPERKALEMIA...IV insulin...dextrose....insulin will move K+ from extra to intracellular - correct answer - Hyperkalemia (high serum potassium) may result from impaired renal excretion, a shift of potassium from ICF to ECF, a massive intake of potassium, or a combination of all of these, - In metabolic acidosis (poorly managed diabetes), potassium ions shift from ICF to ECF in exchange for hydrogen ions moving into the cell. Both digoxin like drugs and beta-adrenergic blockers (Afib treaters) can impair entry of potassium into cells, resulting in higher ECF potassium concentration, - some meds reduce the kidneys ability to excrete potassium How to manage HYPERKALEMIA...IV insulin...dextrose....insulin will move K+ from extra to intracellular - correct answer Treatment: Force potassium from ECF to ICF accomplished by IV administration of regular insulin (along with glucose so the patient does not become

solution hypoglycemic). Occasionally, a beta- adrenergic agonist (nebulizer albuterol) is administered. not indicated for Pt's with tachycardia or CAD.