Nokea
The nurse is caring for an infant admitted to the hospital with a diagnosis of hemolytic disease. Which finding should the nurse expect to note in this infant when reviewing the laboratory results?
- A. Decreased bilirubin count
- B. Elevated blood glucose level
- C. Decreased red blood cell count
- D. Decreased white blood cell count
Correct Answer: C
Rationale: The two primary pathophysiological alterations associated with hemolytic disease are anemia and hyperbilirubinemia. The red blood cell count is decreased because red blood cell production cannot keep pace with red blood cell destruction. Hyperbilirubinemia results from the red blood cell destruction that accompanies this disorder and from the normally decreased ability of the neonate's liver to conjugate and excrete bilirubin efficiently from the body. Hypoglycemia is associated with hypertrophy of the pancreatic islet cells and increased levels of insulin. The white blood cell count is not related to this disorder.
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A 3-week-old infant is brought to the well-baby clinic for a phenylketonuria (PKU) screening test. The nurse reviews the results of the serum phenylalanine levels and notes that the level is 1.0 mg/dL (60 mmol/L). What is the nurse's priority action?
- A. Report the test as inconclusive.
- B. Tell the mother that the test is normal.
- C. Prepare to perform another test on the client.
- D. Notify the pediatrician that the test is moderately elevated.
Correct Answer: A
Rationale: The normal PKU level is 0.8 to 1.8 mg/dL (48 to 109 mmol/L). With early postpartum discharge, screening is often performed when the infant is less than 2 days old because of the concern that the infant will be lost to follow-up. Infants should be rescreened by the time that they are 14 days old if the initial screening was done when the infant was 24 to 48 hours old.
A child diagnosed with seizures is being treated with carbamazepine. The nurse reviews the laboratory report for the results of the drug plasma level and determines that the plasma level is in a therapeutic range if which is noted?
- A. 1 mcg/mL (4.2 mcmol/L)
- B. 10 mcg/mL (42.3 mcmol/L)
- C. 18 mcg/mL (76.1 mcmol/L)
- D. 20 mcg/mL (84.6 mcmol/L)
Correct Answer: B
Rationale: When carbamazepine is administered, plasma levels of the medication need to be monitored periodically to check for the child's absorption of the medication. The amount of the medication prescribed is based on the results of this laboratory test. The therapeutic plasma level of carbamazepine is 5 to 12 mcg/mL (21.16 to 50.80 mcmol/L). Option 1 indicates a low level that possibly necessitates an increased medication dose. Options 3 and 4 identify elevated levels that indicate the need to decrease the medication dose.
The nurse is reviewing the laboratory analysis of cerebrospinal fluid (CSF) obtained during a lumbar puncture from a child who is suspected of having bacterial meningitis. Which result would most likely confirm this diagnosis?
- A. Clear CSF with low protein and low glucose
- B. Cloudy CSF with low protein and low glucose
- C. Cloudy CSF with high protein and low glucose
- D. Decreased pressure and cloudy CSF with high protein
Correct Answer: C
Rationale: A diagnosis of meningitis is made by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include increased pressure and cloudy CSF with high protein and low glucose. Therefore, options 1, 2, and 4 are incorrect.
The nurse is developing a plan of care for a client in Buck's (extension) traction. The nurse should determine that which is a priority client problem?
- A. Immobility
- B. Risk of infection
- C. Altered independence
- D. Insufficient sensory stimulation
Correct Answer: A
Rationale: The priority client problem in Buck's traction is immobility. Options 3 and 4 may also be appropriate for the client in traction, but immobility presents the greatest risk for the development of complications. Buck's traction is a skin traction, and there are no pin sites.
A client diagnosed with myasthenia gravis is reporting vomiting, abdominal cramps, and diarrhea. The nurse notes that the client is hypotensive and experiencing facial muscle twitching. Which possible situation does this assessment data support?
- A. Myasthenic crisis
- B. Cholinergic crisis
- C. Systemic infection
- D. Reaction to plasmapheresis
Correct Answer: B
Rationale: Signs and symptoms of cholinergic crisis include nausea, vomiting, abdominal cramping, diarrhea, blurred vision, pallor, facial muscle twitching, pupillary miosis, and hypotension. It is caused by overmedication with cholinergic (anticholinesterase) medications, and it is treated by withholding medications. Myasthenic crisis is an exacerbation of myasthenic symptoms caused by undermedication with anticholinesterase medications. There are no data in the question to support the remaining options.