Chapter 19: Laboratory and Diagnostic Tests My Nursing Test Banks

Chapter 19: Laboratory and Diagnostic Tests

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. The leukocyte count of an older adult patient is elevated. The nurse shows the best understanding of the effect of aging on body function when:

a.

checking the patient for drug allergies before requesting an antibiotic prescription.

b.

asking that the patients temperature be taken before notifying the physician.

c.

encouraging the patient to drink several glasses of water and then repeat the laboratory tests.

d.

having the patient produce a urine sample and requesting a stat urinalysis.

ANS: B

When interpreting laboratory values and deciding the best course of treatment, the older adult should be viewed holistically: signs, symptoms, and test results, such as the patients temperature, should all be taken into account.

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2. The nurse helps minimize an older adult patients risk of developing pernicious anemia by:

a.

suggesting supplementing vitamin A.

b.

encouraging regular intake of citrus.

c.

identifying iron-rich foods.

d.

suggesting supplementing vitamin B12.

ANS: D

Malabsorption of B12 can be caused by the effect of antibodies on gastric parietal cells and a decrease in intrinsic factor, the underlying cause of pernicious anemia. The prevalence of pernicious anemia increases significantly with aging. Pernicious anemia is not associated with vitamin A, citrus, or iron.

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3. The nurse suspects that an acute postoperative infectious process may be developing in your older adult patient. What abnormal finding best supports this suspicion?

a.

A thrombocyte count of 40,000/mm3

b.

Decreasing erythrocyte sedimentation rate of 10 to 20 mm/hr

c.

Increasing C-reactive protein level

d.

Increased partial prothrombin time

ANS: C

C-reactive protein is a marker present in the acute phase of an inflammatory response. The other lab values do not indicate infection.

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4. On assessing the laboratory data of an older adult patient, the nurse notes the serum potassium level is 5.3 mEq/L. Based on this information, the nurse:

a.

asks if the patient has been using a nonsteroidal antiinflammatory drug (NSAID).

b.

determines if the patient is receiving a diuretic that promotes potassium loss.

c.

suggests several potassium-rich foods to supplement dietary potassium intake.

d.

monitors the patients urinary output for possible fluid retention.

ANS: A

A potassium level of 5.3 mEq/L is high. NSAIDs such as ibuprofen interfere with potassium excretion. The other answers are not related to hyperkalemia.

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5. An older adult patient is experiencing symptoms commonly associated with hyperglycemia. Which laboratory test is most reliable for detecting hyperglycemia in older adults?

a.

A random serum glucose

b.

An oral glucose tolerance test

c.

An early morning urine test for glucose

d.

A 24-hour urine glucose test

ANS: B

Appropriate glucose testing includes a fasting blood glucose, an oral glucose tolerance test, and the hemoglobin A1C. The other options are not appropriate.

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6. An older patient has a pressure ulcer that is resistant to healing despite aggressive therapy. The nurse suspects the need for a protein supplement based on a(n):

a.

serum creatinine level of 1.1 mg/dL.

b.

acid phosphate level of 0.9 U/L.

c.

folate level of 18.2 ng/mL.

d.

serum albumin level of 3.1 g/dL.

ANS: D

In older adults with impaired skin integrity related to pressure ulcers, assessment of the albumin level helps determine whether the protein balance is correct for proper wound healing to occur. Older adults with low albumin levels need nutritional support to promote healing of wounds. The other lab values are not related.

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7. An older adult patient has an elevated prostate-specific antigen (PSA) level. The nurse shares with him that a diagnosis of prostate cancer would be confirmed with an analysis of his:

a.

alkaline phosphatase level.

b.

acid phosphatase level.

c.

serum amylase level.

d.

uric acid level.

ANS: B

Acid phosphatase is an enzyme that is primarily located in the prostate gland. Acid phosphatase levels are used to diagnose prostate cancer and to estimate the extent of the disease. The other values are not related.

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8. The nurse explains to an older patient that the assessment of her thyroid health will require both a physical examination as well as laboratory test because:

a.

thyroid studies are less accurate in older adults.

b.

symptoms are similar to those caused by various infections.

c.

thyroid problems can be present without overt symptoms.

d.

T3 levels are normally increased during aging.

ANS: C

The presence of thyroid disease in older adults can be difficult to determine and can be present without overt symptoms. Classic signs of thyroid disorders seen in younger adults are often absent or clouded because of concomitant illnesses in older adults. The other options are not correct statements.

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9. A 91-year-old patient learns that his urine protein is 8.2 mg/100 mL. When asked to explain the significance of the result, the nurse replies:

a.

It may be elevated because of a urinary tract infection.

b.

The result is not significant because its within normal limits.

c.

The level is usually elevated in people your age.

d.

Mild chronic renal failure causes a decrease in urine protein.

ANS: A

The presence of high protein levels in the urine warrants investigation to rule out a urinary tract infection or kidney disease.

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10. A 71-year-old patient has a cholesterol level of 182 mg/dL. The nurse evaluates this as:

a.

high.

b.

low.

c.

normal.

d.

unknown; no norms have been established for this age group.

ANS: A

The American Heart Association views a triglyceride level of < 100 mg/dL as desirable.

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11. The nurse is caring for an 88-year-old patient who was admitted to the long-term care facility after a recent conviction of driving while intoxicated. On reviewing the laboratory work and observing a folic acid level of 2 ng/ml, the nurse:

a.

increases the patients caloric intake.

b.

performs a dietary assessment on the patient.

c.

provides the patient with sodium-rich foods.

d.

immediately notifies the patients physician.

ANS: D

This folic acid level is very low. Alcohol is known to interfere with the absorption of folate. The nurse should immediately notify the physician. Increasing calories will not in itself increase folate levels. A dietary assessment may be warranted but is not the best response. Sodium is not related.

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12. A 66-year-old patient has a decreased calcium level. The nurse anticipates a(n):

a.

elevated sodium level.

b.

elevated phosphorus level.

c.

decreased magnesium level.

d.

decreased serum glucose level.

ANS: B

Calcium metabolism is one of the factors that determines phosphorus levels; an inverse relationship is present. A decrease in calcium can cause an increase in phosphorus and vice versa.

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13. A patients oxygen saturation is 98%, but the patient reports shortness of breath with activity. What action by the nurse is best?

a.

Assess the patients hemoglobin.

b.

Apply oxygen at 2L/nasal cannula.

c.

Consult respiratory therapy.

d.

Administer a bronchodilator.

ANS: A

If the patients hemoglobin is low, there may not be sufficient oxygen in the blood for the patients needs. The nurse assesses the hemoglobin level. Applying oxygen may help the patient feel better but does not get to the root of the problem. Respiratory therapy and a bronchodilator are not indicated.

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14. A patient has increased total iron binding capacity and transferrin levels. What action by the nurse is best?

a.

Prepare to administer vitamin B12.

b.

Encourage the patient to eat protein.

c.

Ensure the patient gets sun exposure.

d.

Prepare the patient for chelating therapy.

ANS: B

High levels of transferrin and iron binding capacity may indicate iron deficiency anemia, so the nurse encourages the patient to eat more protein. The other options are not appropriate.

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15. An older female patient develops gout and says, Why did I get this now? What response by the nurse is best?

a.

Gout can strike anyone at any time.

b.

Your body apparently makes more uric acid now.

c.

Uric acid rarely rises in premenopausal women.

d.

Women actually have more gout than men do.

ANS: C

Because of the role of estrogen in the excretion of uric acid, elevated levels are usually not seen before menopause in women. The other statements are incorrect.

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16. An older patient takes warfarin (Coumadin). The patients international normalized ratio (INR) is 1.0. What action by the nurse is best?

a.

Nothing; this level is therapeutic.

b.

Assess the patients diet history.

c.

Prepare to administer vitamin K.

d.

Double the warfarin dose.

ANS: B

The therapeutic INR is 2-3 (2-3.5 in some sources), so this level is not therapeutic. Foods rich in vitamin K antagonize warfarin. Before consulting the provider about adjusting the dose, the nurse should first assess the patients diet history to see if too many vitamin Krich foods are being eaten. The dose may need adjustment. Vitamin K would be given for an overdose.

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17. An older adult has been admitted for dehydration. Which laboratory value correlates with this condition?

a.

Na+: 160 mEq/L

b.

Na+: 128 mEq/L

c.

K+: 3.5 mEq/L

d.

K+: 5.2 mEq/L

ANS: A

A sodium level of Na+: 160 mEq/L is high and can be seen in cases of dehydration. Overhydration will produce a low sodium level. Potassium levels are not related.

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18. A patient has a low sodium level but normal blood osmolarity. What does the nurse understand about this condition?

a.

The two values are not related.

b.

The patient is overhydrated.

c.

The patient has pseudohyponatremia.

d.

The patient has end-stage kidney disease.

ANS: C

Pseudohyponatremia is a condition in which the serum sodium is low, but osmolarity remains normal. The patient is not overhydrated nor does he or she have end-stage renal disease.

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19. A patient has heart failure and takes spironolactone (aldactone). What diet selection from the menu shows that the patient needs more education?

a.

A low-fat chicken salad sandwich

b.

Salt-free vegetable soup

c.

Broiled fish with lemon

d.

Salt substitute and pepper

ANS: D

Older patients have difficulty excreting potassium because of age-related kidney changes. This patient also takes aldactone, a potassium sparing diuretic. If the patient adds a salt substitute, normally high in potassium, the chances of developing hyperkalemia are high. The nurse needs to provide education on other ways to flavor foods. The other diet choices are fine.

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20. An older patients BUN is 28 mg/dL and creatinine is 0.6 mg/dL. How does the nurse interpret these findings?

a.

Normal for all age groups

b.

Normal for older adults

c.

High for all age groups

d.

Low for older adults

ANS: B

The older adult may have elevated blood urea nitrogen (BUN) because of age-related decreases in kidney function and a lowered creatinine resulting from decreased muscle mass.

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21. An 85-year-old patients blood gasses are as follows: pH 7.4, PAO2 75 mmHg, PACO2 38 mmHg, HCO3 25. What action by the nurse is best?

a.

Administer oxygen per facemask

b.

Assess the patients shortness of breath

c.

Assess the patients oxygen saturation

d.

Document the findings in the chart

ANS: D

These values are normal for the patients age. If the patient had complaints, the nurse would perform further assessments, but because the patient does not appear to have complaints, the nurse documents the results.

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22. A patient was admitted for heart failure, and over the past 3 days the patients brain natriuretic peptide has decreased. What action by the nurse is best?

a.

Prepare to administer extra diuretics.

b.

Continue with the plan of care.

c.

Prepare to intubate and ventilate the patient.

d.

Discuss end-of-life care with the patient.

ANS: B

A decreasing BNP indicates less fluid volume in the heart, indicating that treatment measures for CHF are working. The nurse continues with the plan of are. The other actions are not needed.

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23. A patient takes digoxin (Lanoxin) for heart failure with atrial fibrillation. The patient reports yellow vision and nausea. The patients digoxin level is 1.9 ng/mL. How does the nurse explain the situation to the patient?

a.

Even with a normal blood level you may have digoxin toxicity.

b.

You may have a gastrointestinal virus that is causing these symptoms.

c.

You may not be getting a high enough dose of digoxin; Ill call the doctor.

d.

Your cataracts may be worsening and you may need to have them removed.

ANS: A

This digoxin level is normal; however, older adults can get digoxin toxicity even with normal blood levels. The other answers are not accurate.

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