CBC
What does a CBC include? What does each component tell us?
1)RBC count: CO2 and O2 transport, Tells us amount, size, amount of Hg on each individual RBC
2)Total WBC count: Count of total WBC, Immune response and system, how well the body fights infections
3)Differential WBC: Tells us amount of each different type of WBC
4)Hematocrit: Packed cell volume; percentage of RBCs in whole blood.
5)Hemoglobin level: protein responsible for binding with oxygen, gives RBC color, tells us health of RBC
5)Platelets: number in your blood; how well blood clots and wound healing
What are the normal adult ranges for BUN and Creatinine?
BUN: 10-20mg/dL
TRY* 10-20 hot buns (the Hawaiian buns from HEB)
Creatinine: M- 0.6-1.3, F- 0.5-1.1
TRY* creatinine stays close to one, Males by 3s and Females can be odd
Which laboratory values are included in a Comprehensive Metabolic Panel (CMP) but NOT included in a Basic Metabolic Panel (BMP)?
A. Sodium and potassium
B. Glucose and calcium
C. AST and ALT
D. BUN and creatinine
C. AST and ALT
CMP = BMP + liver function markers + protein levels.
Liver enzyme markers include: ALT (Liver function only), ALP (Bone and bile function), AST (Liver and muscle, nonspecific to liver)
Albumin= liver protein, synthesized directly in liver
Bilirubin= waste product of hemolysis processed in liver (but from circulatory)
Which component of a lipid panel is commonly referred to as “good cholesterol” because it helps remove excess cholesterol from the bloodstream?
A. LDL
B. HDL
C. Triglycerides
D. Total cholesterol
B. HDL
Clinical significance:
HDL helps transport cholesterol to the liver for removal, reducing risk of cardiovascular disease.
Which cardiac marker is considered the most specific indicator of myocardial damage?
A. CK
B. Myoglobin
C. Troponin
D. Sodium
C. Troponin
Clinical significance:
Troponin is released when heart muscle cells are damaged, making it the most specific test for myocardial infarction
Normal WBC count
5,000-10,000
A client’s BMP shows:
Sodium 150 mEq/L
Which assessment finding is most consistent with this result?
A. Confusion and dry mucous membranes
B. Muscle twitching and tingling
C. Bradycardia and weakness
D. Diarrhea and abdominal cramping
A. Confusion and dry mucous membranes
Rationale:
- Normal range 135-145
- 150= HYPERnatremia (elevated sodium)
- Think: salty and dry; salt ocean water dries out mouth and increases thirst
-Addition: Where water flows solutes go (AKA Sodium); however, when distribution caused by sodium excess in the brain then creates osmotic gradient that draws water out to maintain balance. Leading to neurological symptoms bc brain cell function is disrupted.
A client’s CMP shows:
Albumin 2.8 g/dL
Which condition is most associated with this finding?
A. Dehydration
B. Malnutrition
C. Hyperkalemia
D. Respiratory alkalosis
B. Malnutrition
Normal albumin: 3.5–5.0
Low albumin = poor protein intake or liver dysfunction
Albumin is made in the liver.
Liver requires adequate protein to be synthesized in the liver (Albumin=liver protein), lack of dietary restriction means reduced production.
A client’s lipid panel reveals LDL 175 mg/dL.
Why is this finding concerning?
A. It increases the risk for atherosclerosis
B. It indicates dehydration
C. It causes hypoglycemia
D. It leads to electrolyte imbalance
A. It increases the risk for atherosclerosis
Clinical significance:
High LDL contributes to plaque formation in arteries, increasing risk for heart attack and stroke.
Which cardiac marker may increase earliest after muscle injury but is not specific to cardiac muscle?
A. Troponin
B. CK-MB
C. Myoglobin
D. Albumin
C. Myoglobin
Explanation:
Myoglobin rises within 1–3 hours after muscle injury but can also increase with skeletal muscle damage, so it is not heart-specific
Normal Platelet Count
150,000-400,000
A client’s BMP shows:
Potassium 2.9 mEq/L
Which finding after review of lab level requires immediate follow-up?
A. Mild fatigue
B. Irregular heart rhythm
C. Constipation
D. Decreased appetite
B. Irregular heart rhythm
Potassium 3.5–5.0 normal
2.9 = hypokalemia
Low K+ = lethal arrhythmias and dysrhythmias risk
Cardiac > everything
A client’s CMP reveals:
ALT 145
AST 130
Which assessment finding is most consistent with these results?
A. Yellowing of the sclera
B. Muscle weakness
C. Tingling in fingers
D. Bradycardia
A. Yellowing of the sclera
Elevated AST/ALT = liver injury
Think hepatitis, toxicity, or inflammation.
Jaundice is the classic sign.
ALT is often seen to be elevated in alcoholics.
ALT: 4-36
AST:0-35
ALP:30-120
A client’s lipid panel shows triglycerides 260 mg/dL.
Which teaching should the nurse provide?
A. Increase saturated fat intake
B. Reduce sugar and alcohol intake
C. Increase sodium intake
D. Limit water intake
B. Reduce sugar and alcohol intake
Clinical significance:
High triglycerides are associated with:
Obesity
Diabetes
Increased cardiovascular risk
Which cardiac marker is most useful in identifying a reinfarction (second heart attack) because it returns to normal relatively quickly?
A. Troponin
B. CK-MB
C. Myoglobin
D. LDL
B. CK-MB
Explanation:
CK-MB rises within 3–6 hours, peaks at about 24 hours, and returns to normal in 48–72 hours, making it helpful in detecting a second myocardial infarction.
Normal RBC Range
RBC: F- 4.2-5.4, M- 4.7-6.1
A client’s BMP reveals:
Calcium 11.5 mg/dL
Which clinical manifestation is most likely?
A. Muscle spasms and tetany
B. Hyperactive reflexes
C. Lethargy and constipation
D. Seizures
C. Lethargy and constipation
Calcium 9–10.5 normal
High calcium = slow everything down
“Stones, bones, groans, and psychiatric overtones.”
Tetany and seizures are LOW calcium.
Calcium stabilizes nerve membranes; low-> nerves uncontrollable/excitable on own so seizures
NOTE: Vitamin D assists with calcium absorption
A client’s CMP shows:
Bilirubin 3.5 mg/dL
AST elevated
ALT elevated
Albumin low
Which clinical finding is most concerning?
A. Dry mucous membranes
B. Peripheral edema
C. Hyperactive reflexes
D. Muscle spasms
B. Peripheral edema
Why?
Low albumin = decreased oncotic pressure → fluid leaks → edema.
Liver dysfunction pattern.
This question tests understanding of liver synthesis function.
A nurse is preparing a client for a lipid panel. Which instruction is most appropriate?
A. Avoid fluids for 24 hours
B. Fast for 9–12 hours before the test
C. Avoid exercise for 1 week
D. Increase protein intake before testing
B. Fast for 9–12 hours
Clinical significance:
Food intake can falsely elevate triglyceride levels
The nurse is caring for a client admitted with suspected myocardial infarction. The provider orders serial troponin levels every 6 hours. What is the primary reason for obtaining serial troponin measurements?
A. Troponin levels fluctuate rapidly throughout the day
B. Troponin levels may rise several hours after cardiac injury
C. Troponin levels decrease immediately after myocardial damage
D. Troponin is only detectable in the bloodstream for one hour
B. Troponin levels may rise several hours after cardiac injury
Explanation:
Troponin levels do not rise immediately after myocardial injury. They typically begin to increase 3–6 hours after heart muscle damage and remain elevated for several days. Because of this delay, providers often order serial troponin measurements to confirm or rule out myocardial infarction
Normal Hg Range
Hg: F- 12-16, M- 14-18
The nurse reviews the BMP of four clients. Which client requires priority intervention?
A. Sodium 130, reports headache
B. Potassium 6.2, reports muscle weakness
C. Calcium 7.8, reports tingling in fingers
D. Glucose 240, reports increased thirst
B. Potassium 6.2
Why?
Potassium 6.2 = hyperkalemia
Life-threatening arrhythmia risk.
Even though:
Sodium 130 = low; brain
Calcium 7.8 = low; bones
Glucose 240 = high; blood sugar
Potassium abnormalities kill fastest.
Cardiac rhythm always wins priority.
A client’s CMP shows:
Potassium 6.0
Creatinine 3.1
BUN 42
Albumin 3.8
AST/ALT normal
The client reports decreased urine output and generalized weakness.
What is the nurse’s priority action?
A. Encourage oral fluids
B. Notify the provider immediately
C. Educate on low-protein diet
D. Document and recheck in 4 hours
B. Notify the provider immediately
Why?
This is acute kidney injury:
High potassium = cardiac risk
High creatinine + BUN = renal failure
Decreased urine output
Hyperkalemia + kidney dysfunction = life-threatening.
Cardiac rhythm risk always wins.
The nurse reviews lipid panel results for four clients. Which client requires priority follow-up?
A. Total cholesterol 210 mg/dL, HDL 65
B. LDL 190 mg/dL, family history of heart disease
C. Triglycerides 160 mg/dL, BMI 29
D. HDL 38 mg/dL, sedentary lifestyle
B. LDL 190 mg/dL
Clinical significance:
LDL levels this high significantly increase risk for atherosclerotic cardiovascular disease and often require aggressive treatment
A client presents with chest pain. Laboratory results show:
Troponin: 3.1 ng/mL
CK-MB: 18 ng/mL
What do these findings most strongly suggest?
A. Liver failure
B. Skeletal muscle injury
C. Myocardial infarction
D. Kidney disease
C. Myocardial infarction
Explanation:
Elevated troponin and CK-MB together strongly indicate damage to cardiac muscle, which is consistent with a heart attack