Random Lab
an enzyme that plays a crucial role in energy production within cells, particularly in muscle tissues.
Creatine kinase (CK)
less than 200 mg/dL
Total Cholesterol
A nurse is caring for a patient who is scheduled for an upper gastrointestinal (GI) endoscopy. Which of the following is the most important action for the nurse to take before the procedure?
A) Ensure the patient has been NPO (nothing by mouth) for 6-8 hours.
B) Explain that the procedure will take approximately 30 minutes.
C) Verify that the patient has signed the informed consent form.
D) Inform the patient that they may experience a sore throat afterward.
Correct Answer: C) Verify that the patient has signed the informed consent form.
Rationale:
C) Verifying that the patient has signed the informed consent form is the most important action before the procedure. Informed consent is a legal and ethical requirement, ensuring that the patient understands the procedure, its risks, benefits, and alternatives, and agrees to proceed.
A nurse is preparing to administer a medication to a patient. Which of the following actions is the most effective way to ensure the right patient receives the medication?
A) Ask the patient to state their full name and date of birth.
B) Verify the patient's room number before administering the medication.
C) Check the patient's wristband against the medication administration record (MAR).
D) Confirm the patient's identity with a family member present in the room.
Correct Answer: C) Check the patient's wristband against the medication administration record (MAR).
Rationale:
C) Checking the patient's wristband against the MAR is the most reliable method to ensure the right patient receives the medication. This practice helps prevent errors by verifying the patient's identity using two identifiers.
A nurse is performing a cardiopulmonary assessment on a patient who has been admitted with shortness of breath. Which of the following findings should the nurse report immediately to the healthcare provider?
A) Respiratory rate of 20 breaths per minute
B) Oxygen saturation of 88% on room air
C) Heart rate of 82 beats per minute
D) Blood pressure of 118/76 mmHg
Correct Answer:
B) Oxygen saturation of 88% on room air
Rationale:
B) An oxygen saturation of 88% on room air is below the normal range (typically 95-100%) and indicates hypoxemia, which requires immediate attention and intervention to prevent further complications.
Is a substance produced by the liver in response to inflammation. It is a part of the body's immune response and is often measured in the blood to assess the presence and intensity of inflammation.
C-reactive protein (CRP)
Less than 130 mg/dL
LDL
A nurse is preparing a patient for a liver biopsy. Which of the following actions is the priority for the nurse to take immediately after the procedure?
A) Monitor the patient's vital signs every 15 minutes for the first hour.
B) Position the patient on their left side to promote comfort.
C) Instruct the patient to avoid eating or drinking for 2 hours.
D) Apply a warm compress to the biopsy site to reduce discomfort.
Correct Answer: A) Monitor the patient's vital signs every 15 minutes for the first hour.
Rationale:
A) Monitoring the patient's vital signs closely after a liver biopsy is crucial because it helps detect any signs of bleeding or complications early. The liver is a highly vascular organ, and bleeding is a significant risk following a biopsy.
A nurse is preparing to administer a medication to a patient. Which of the following actions is most important to ensure the right drug is given?
A) Ask the patient if they have taken this medication before.
B) Compare the medication label with the medication administration record (MAR) three times.
C) Verify the medication with another nurse before administration.
D) Check the expiration date on the medication package.
Correct Answer: B) Compare the medication label with the medication administration record (MAR) three times.
Rationale:
B) Comparing the medication label with the MAR three times is a critical step in ensuring the right drug is administered. This process, often referred to as the "three checks," involves verifying the medication when it is taken from the storage area, before preparing it, and before administering it to the patient.
A nurse is assessing a patient with Chronic Obstructive Pulmonary Disease (COPD) who is experiencing increased shortness of breath. Which of the following assessment findings should the nurse report immediately to the healthcare provider?
A) Use of accessory muscles during respiration
B) Oxygen saturation of 90% on 2 liters of oxygen via nasal cannula
C) Barrel-shaped chest
D) Respiratory rate of 22 breaths per minute
Correct Answer: A) Use of accessory muscles during respiration
Rationale:
A) The use of accessory muscles during respiration indicates increased work of breathing and respiratory distress, which requires immediate attention and potential intervention.
Is a blood test that measures average blood sugar levels over the past 2-3 months.
A1C
HDL
A nurse is preparing a patient for a colonoscopy scheduled for the next morning. Which of the following instructions should the nurse include in the teaching plan? (Select all that apply.)
A) "You should avoid eating solid foods starting the day before the procedure."
B) "You will need to drink a bowel-cleansing solution as prescribed."
C) "You can take your routine medications with a small sip of water on the morning of the procedure."
D) "You should expect to feel some abdominal cramping during the procedure."
E) "You will be able to drive yourself home after the procedure."
Correct Answers:
A) "You should avoid eating solid foods starting the day before the procedure."
B) "You will need to drink a bowel-cleansing solution as prescribed."
C) "You can take your routine medications with a small sip of water on the morning of the procedure."
Rationale:
A) Patients are typically instructed to follow a clear liquid diet the day before a colonoscopy to ensure the bowel is adequately cleansed.
B) Drinking a bowel-cleansing solution is a standard preparation step to clear the intestines of any stool, allowing for better visualization during the procedure.
C) Most patients are allowed to take their routine medications with a small sip of water on the morning of the procedure, but they should confirm this with their healthcare provider.
A nurse is preparing to administer a medication to a patient. Which of the following actions is most important to ensure the right dosage is given?
A) Ask the patient if they have experienced any side effects from this medication in the past.
B) Calculate the dosage based on the patient's weight and compare it with the prescribed dose.
C) Verify the dosage with another nurse before administration.
D) Check the patient's vital signs before administering the medication.
Correct Answer:
B) Calculate the dosage based on the patient's weight and compare it with the prescribed dose.
Rationale:
B) Calculating the dosage based on the patient's weight and comparing it with the prescribed dose is crucial, especially for medications that require weight-based dosing. This ensures that the patient receives the correct amount of medication.
A nurse is performing a physical examination on a patient who presents with chest pain. Which of the following findings should the nurse report immediately to the healthcare provider?
A) Bilateral breath sounds clear to auscultation
B) Jugular vein distention at 45 degrees
C) Capillary refill time of less than 2 seconds
D) Warm and dry skin
Correct Answer: B) Jugular vein distention at 45 degrees
Rationale:
B) Jugular vein distention (JVD) at 45 degrees can indicate increased central venous pressure, which may be associated with conditions such as heart failure, cardiac tamponade, or tension pneumothorax. This finding is significant in the context of chest pain and should be reported immediately.
lso known as transthyretin, is a protein produced primarily by the liver. It serves as a transport protein for thyroid hormones and retinol (vitamin A) and is often used as a marker to assess nutritional status, particularly protein-calorie malnutrition.
Less than 160 mg/dL (male) and 135 mg/dL (female)
Triglycerides
A nurse is providing instructions to a patient scheduled for a barium enema the next day. Which of the following instructions is most important for the nurse to include in the teaching?
A) "You should avoid eating or drinking anything after midnight before the procedure."
B) "You will need to drink a special contrast solution the morning of the procedure."
C) "You can have a light breakfast on the morning of the procedure."
D) "You should take a laxative the night before the procedure as directed."
Correct Answer: D) "You should take a laxative the night before the procedure as directed."
Rationale:
D) Taking a laxative the night before a barium enema is crucial to ensure the colon is clear of stool, which allows for optimal visualization during the procedure.
A nurse has just administered a medication to a patient. Which of the following actions is most important to ensure the right documentation?
A) Document the medication administration before giving the medication to the patient.
B) Record the medication name, dose, route, time, and any patient reactions immediately after administration.
C) Ask the patient to confirm the medication they received and document their response.
D) Document the medication administration at the end of the shift to ensure accuracy.
Correct Answer: B) Record the medication name, dose, route, time, and any patient reactions immediately after administration.
Rationale:
B) Recording the medication name, dose, route, time, and any patient reactions immediately after administration is essential for accurate and timely documentation. This practice ensures that the patient's medical record is up-to-date and reflects the care provided.
A nurse is performing a physical examination on a patient who presents with severe abdominal pain. Which of the following findings should the nurse report immediately to the healthcare provider?
A) Hyperactive bowel sounds
B) Abdominal distention
C) Rebound tenderness
D) Soft and non-tender abdomen
Correct Answer: C) Rebound tenderness
Rationale:
C) Rebound tenderness is a significant finding that may indicate peritoneal irritation, such as in cases of appendicitis or peritonitis. This requires immediate attention and should be reported to the healthcare provider promptly.
Also known as a lipoprotein panel, is a blood test that measures the levels of cholesterol and other fats in your blood.
Lipid Panel
A 55-year-old male patient with a history of hypertension and smoking undergoes a routine lipid panel test. The results are as follows:
Based on these results, which of the following is the priority nursing intervention?
A) Educate the patient on the importance of increasing dietary fiber intake.
B) Discuss the benefits of starting a regular exercise program.
C) Provide information on smoking cessation programs.
D) Refer the patient to a dietitian for a low-fat diet plan.
Correct Answer:
C) Provide information on smoking cessation programs.
Rationale:
While all the options are important for managing dyslipidemia and reducing cardiovascular risk, smoking cessation is a critical intervention for this patient. Smoking is a major risk factor for cardiovascular disease, and quitting smoking can significantly reduce the risk of heart attacks and strokes. Given the patient's history of smoking and the elevated lipid levels, addressing smoking cessation is a priority. Additionally, smoking cessation can improve HDL cholesterol levels, which are low in this patient. Other interventions, such as dietary changes and exercise, are also important and should be addressed as part of a comprehensive lifestyle modification plan.
Instructions: Match each urine microscopic finding with its most likely clinical significance.
A) Urinary tract infection (UTI)
B) Kidney stones or glomerulonephritis
C) Dehydration or concentrated urine
D) Pyelonephritis or inflammation
E) Possible kidney disease or damage
Answers:
Red Blood Cells (RBCs) - B) Kidney stones or glomerulonephritis
White Blood Cells (WBCs) - A) Urinary tract infection (UTI)
Casts - E) Possible kidney disease or damage
Crystals - C) Dehydration or concentrated urine
Bacteria - A) Urinary tract infection (UTI)
A nurse is reviewing a prescription written by a healthcare provider. Which of the following components must be present for the prescription to be considered valid? (Select all that apply.)
A) Patient's full name
B) Date the prescription was written
C) Patient's insurance information
D) Name of the medication
E) Dosage and route of administration
F) Prescriber's signature
G) Pharmacy contact information
Correct Answers:
A) Patient's full name
B) Date the prescription was written
D) Name of the medication
E) Dosage and route of administration
F) Prescriber's signature
A nurse is preparing a patient for an intravenous pyelography (IVP) procedure. Which of the following actions is most important for the nurse to take before the procedure?
A) Ensure the patient is NPO (nothing by mouth) for 8 hours before the procedure.
B) Administer a sedative to help the patient relax during the procedure.
C) Check the patient's allergy history, specifically for iodine or shellfish.
D) Encourage the patient to drink plenty of fluids before the procedure.
Correct Answer: C) Check the patient's allergy history, specifically for iodine or shellfish.
Rationale:
C) Checking the patient's allergy history for iodine or shellfish is crucial because the contrast dye used in an IVP contains iodine. An allergy to iodine or shellfish may indicate a risk for an allergic reaction to the contrast dye, and this information must be communicated to the healthcare provider before proceeding.