(Test Bank) Davis's Comprehensive Manual Of Laboratory And Diagnostic Tests With Nursing Implications

Leeuwen, 9

Nursing

Test Bank

9th Edition

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Test Bank for Davis's Comprehensive Manual Of Laboratory And Diagnostic Tests With Nursing Implications, The downloadable file consists of 630 pages, and the total size of the file is 4.73 MB. Purchase now only for highly discounted price.

Author(s): Leeuwen

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1 Van Leeuwen 9e Test Bank Van Leeuwen: Davis’s Comprehensive Manual of Laboratory and Diagnostic Tests with Nursing Implications, 9e Rationales Multiple Choice 1. A nurse is caring for a patient with a diagnosis of chronic myelogenous leukemia (CML). The patient was admitted to an acute care unit with a temperature of 100.4°F (38°C) and weight loss over the past 2 to 3 months. The nurse notes that the patient’s white blood cell (WBC) count is 23 ´ 103/microL (SI = 23 ´ 109/L), and the physical examination shows splenomegaly. The priority nursing intervention should be: 1. avoiding falls. 2. managing pain. 3. preventing infection. 4. promoting adequate nutrition. ANS: 3 Page: 1266 Body System: Circulatory/hematopoietic system, immune system Feedback 1. This is incorrect. Although avoiding falls is important, it is not the main priority for a patient presenting with a diagnosis of CML and leukocytosis. Preventing opportunistic infections should be the priority. 2. This is incorrect. Although managing pain is important, it is not the main priority for a patient presenting with a diagnosis of CML and leukocytosis. Preventing opportunistic infections should be the priority. 3. This is correct. The nurse’s priority should be planning interventions to prevent opportunistic infections for the patient with CML and significant leukocytosis. Focus on promoting good hygiene and assist with hygiene when needed. Administer prescribed antibiotics, and monitor vital signs and trend temperatures. 4. This is incorrect. Although promoting adequate nutrition is important, it is not the main priority for a patient presenting with a diagnosis of CML and leukocytosis. Preventing opportunistic infections should be the priority. 2. A patient with diabetes requires assessment of long-term glucose control. Which test would be most appropriate for this patient? 1. Glycated hemoglobin (Hgb) 2. Glucose 3. Glucose-6-phosphate dehydrogenase (G6PD) 4. Glucose tolerance test ANS: 1 2 Van Leeuwen 9e Test Bank Page: 648 Body System: Circulatory system, endocrine system Feedback 1. This is correct. Glycated hemoglobin is used to indicate long-term glycemic management. 2. This is incorrect. Glucose levels are used to assist in the diagnosis of diabetes and to evaluate disorders of carbohydrate metabolism such as malabsorption syndrome 3. This is incorrect. Glucose-6-phosphate dehydrogenase is used to identify an enzyme deficiency that can result in hemolytic anemia. 4. This is incorrect. The glucose tolerance test is used to evaluate blood glucose levels to assist in diagnosing diabetes. 3. A nurse notes that a patient has a urine pH of 7.6. Which information in the patient’s history may be related to this result? 1. Maintaining a vegetarian diet 2. Training for a marathon 3. Recent febrile illness 4. Use of cranberry supplements daily ANS: 1 Page: 1227 Body System: Urinary system Feedback 1. This is correct. Vegetarian diets may result in an elevated urine pH. 2. This is incorrect. Metabolic or respiratory acidosis that may result from intense physical training results in a lower pH. 3. This is incorrect. Although febrile illness increases urine glucose ketones, it does not influence pH. 4. This is incorrect. Ingestion of cranberries decreases urine pH and therefore would not result in an elevated pH. 4. A patient with pernicious anemia has a laboratory order to test for intrinsic factor (IF) antibodies. A nurse scheduling this test should instruct the patient to: 1. begin a bowel prep 24 hours prior to the examination. 2. eliminate red meat from the diet for 72 hours before the test. 3. take nothing by mouth for 12 hours before the test is to take place. 4. withhold vitamin B12 for 2 weeks before the test is to take place. ANS: 4 Page: 763 Body System: Circulatory/hematopoietic system, digestive system, immune system 3 Van Leeuwen 9e Test Bank Feedback 1. This is incorrect. Bowel prep is not needed prior to this test. 2. This is incorrect. There are no food restrictions unless by medical direction. 3. This is incorrect. There are no food or fluid restrictions unless by medical direction. 4. This is correct. Administration of vitamin B12, injected, ingested, or administered otherwise (e.g., absorbed by nasal gel or sublingual tablet), should be withheld 2 weeks before testing. 5. A nurse observes that a patient admitted to the emergency department with decreased level of consciousness has urine with a very fruity odor. Based on this observation, the nurse should plan interventions to manage: 1. alcohol withdrawal. 2. diabetic ketoacidosis (DKA). 3. fibromyalgia. 4. Lyme disease. ANS: 2 Page: 772 Body System: Endocrine system Feedback 1. This is incorrect. Excessive alcohol use may lead to ketoacidosis, but alcohol withdrawal does not. 2. This is correct. Elevated levels of ketone bodies are evidenced by fruity-smelling breath, acidosis, ketonuria, and decreased level of consciousness. The nurse should plan interventions to manage the diabetic ketoacidosis. Administration of insulin and frequent blood glucose measurement may be indicated. 3. This is incorrect. Fibromyalgia does not influence the level of ketones in urine. 4. This is incorrect. Lyme disease does not influence the level of ketones in urine. 6. A patient must undergo pulmonary angiography but has a history of allergic reaction to some medications. Which of the following actions should be taken in response to this finding? 1. Remove all metallic objects from the area to be examined. 2. Administer an antianxiety agent, as ordered. 3. Use a nonionic contrast medium. 4. Notify the health-care provider (HCP) to cancel the procedure. ANS: 3 Page: 65 Body System: Circulatory system, respiratory system Feedback 1. This is incorrect. Removal of all metallic objects is a standard intervention before any x-ray imaging. 4 Van Leeuwen 9e Test Bank 2. This is incorrect. The nurse can administer an antianxiety agent, as ordered, but this will not influence the risk of an allergic reaction. 3. This is correct. Use of nonionic contrast may be considered for patients who have experienced allergic reactions to medications in the past. 4. This is incorrect. There is no need to cancel the procedure because a nonionic contrast medium can be used. 7. A patient’s laboratory test results following amniotic fluid analysis indicate elevated α1-fetoprotein (AFP) levels and presence of acetylcholinesterase. Which of the following conditions should the nurse most suspect given these findings? 1. Respiratory distress syndrome 2. Fetal hemolytic disease 3. Neural tube defect 4. Fetal immaturity ANS: 3 Page: 55 Body System: Reproductive system Feedback 1. This is incorrect. A lecithin/sphingomyelin ratio of less than 2:1 and absence of phosphatidylglycerol at term indicate fetal lung immaturity and possible respiratory distress syndrome. 2. This is incorrect. Elevated bilirubin levels indicate fetal hemolytic disease. 3. This is correct. Elevated AFP levels and presence of acetylcholinesterase indicate a neural tube defect. 4. This is incorrect. Creatinine concentration greater than 2 mg/dL (greater than 176.8 micromol/L) indicates fetal maturity (at 36 to 37 weeks) if maternal creatinine is also within the expected range. 8. A college student who is admitted to the hospital with newly diagnosed type 1 diabetes has a C-peptide level of 0.6 ng/mL (SI = 0.2 nmol/L) and serum glucose level of 256 mg/dL (SI = 14.2 mmol/L). Based on these results, which instruction should the nurse provide to this patient? 1. “Based on these results, your diabetes will be controlled by oral medications and diet.” 2. “If you lose weight, you may be able to manage your diabetes with diet alone.” 3. “Because you are already an adult, this result confirms that you have type 2 diabetes.” 4. “You will need to take insulin for the rest of your life.” ANS: 4 Page: 427 Body System: Endocrine system Feedback 1. This is incorrect. A low C-peptide indicates insufficient production of insulin by the pancreas and therefore insulin is necessary. 2. This is incorrect. Type I diabetes requires insulin and cannot be managed with 5 Van Leeuwen 9e Test Bank diet alone. 3. This is incorrect. C-peptide levels are typically increased in type 2 diabetes. 4. This is correct. A low C-peptide indicates type 1 diabetes with an elevated blood glucose, so the nurse should instruct the patient that insulin will be required. 9. Which laboratory test should a nurse monitor to determine whether a patient is responding to the administration of iron for iron-deficiency anemia? 1. Eosinophils 2. Lymphocytes 3. Monocytes 4. Reticulocytes ANS: 4 Page: 1077 Body System: Circulatory/hematopoietic system Feedback 1. This is incorrect. Eosinophil count is used to assist in the diagnosis of conditions related to immune responses, such as asthma, dermatitis, and hay fever and also assist in the identification of parasitic infections. 2. This is incorrect. Lymphocytes are white blood cells produced in the bone marrow and thymus and are used to assess infection. 3. This is incorrect. Monocytes are white blood cells that are used to assess infection. 4. This is correct. If the patient is responding to the administration of iron for iron-deficiency anemia, the nurse would expect to see increased reticulocytes, immature red blood cells produced by the bone marrow. 10. A patient has had an indwelling urinary catheter inserted to collect urine for a 24-hour creatinine clearance test. To begin the test, the nurse should: 1. collect all urine during any 24-hour period by labeling the drainage collection bag with the date and time most recently emptied. 2. clamp the urinary catheter and then drain all urine into the container specified by the laboratory and repeat every 6 hours times 4. 3. empty all urine in the urinary drainage bag at 0600 and then save all urine until the next day at 0600. 4. increase meat portions in the diet for at least 48 hours prior to the planned start of the collection. ANS: 3 Page: 443 Body System: Musculoskeletal system, urinary system Feedback 1. This is incorrect. The collection bag should include the urine total volume, test start and stop times/dates, and any medications that may interfere with test 6 Van Leeuwen 9e Test Bank results. 2. This is incorrect. All urine voided for the 24-hour collection period must be included in one collection or else inaccurate results may be obtained. 3. This is correct. The accuracy of the creatinine clearance test requires careful collection of urine over a defined 24-hour period, so the nurse must empty all urine in the urinary drainage bag or, if the patient is not catheterized, ask the patient to void and discard the first specimen at 0600. Then save all urine until the next day at 0600. 4. This is incorrect. Meat is metabolized to creatinine and excreted by the kidneys and therefore may invalidate results. 11. A nurse is preparing to assist with performing a lumbar puncture to collect a specimen for diagnosis of Alzheimer disease. Which position should the nurse ask the patient to assume for this test? 1. Knee-chest 2. Side-lying 3. Prone 4. Standing ANS: 1 Page: 309 Body System: Immune system, nervous system Feedback 1. This is correct. Positioning is typically the knee-chest lateral recumbent (lateral decubitus, Sims, or side-lying) position for maximum spinal flexion and widening of intervertebral spaces. Pillows may need to be placed between the legs to support the spine. 2. This is incorrect. The side-lying position is not appropriate for this test. 3. This is incorrect. The prone position is not appropriate for this test. 4. This is incorrect. The standing position is not appropriate for this test. 12. Which blood tests should a nurse monitor to determine whether a patient’s blood level of warfarin [CA = warfarin sodium] is within the therapeutic range? 1. Activated partial thromboplastin time (aPTT) 2. Bleeding time 3. Platelet count and aPTT 4. Prothrombin time (PT) and international normalized ratio (INR) ANS: 4 Page: 937 Body System: Circulatory/hematopoietic system Feedback 1. This is incorrect. The aPPT time represents the time required for formation of a firm fibrin clot after tissue thromboplastin reagents and calcium are added to a 7 Van Leeuwen 9e Test Bank plasma specimen. 2. This is incorrect. Bleeding time studies provide measurable responses that represent the time it might take for platelet closure to occur after a vascular injury. 3. This is incorrect. Platelet counts are used to assist in diagnosing and evaluating treatment for blood disorders and to evaluate coagulation status. aPTT is used to indicate factor deficiencies and assists in assessing coagulation disorders. 4. This is correct. The PT and INR should both be monitored to determine the therapeutic range for a patient receiving warfarin. The PT is used to evaluate the tissue factor pathway, formerly called the extrinsic pathway, of the coagulation sequence in patients receiving oral warfarin anticoagulants. 13. A nurse has just conducted hearing loss audiometry testing on a 10-year-old patient. The patient’s pure tone average was 52 dB. Which category of hearing of the American Speech-Language-Hearing Association (ASHA) does this result represent? 1. Normal 2. Slight loss 3. Moderate loss 4. Profound loss ANS: 3 Page: 126 Body System: Nervous system Feedback 1. This is incorrect. Normal range is −10 to 15 dB. 2. This is incorrect. Slight loss is 16 to 25 dB. 3. This is correct. Moderate loss is 41 to 55 dB. 4. This is incorrect. Profound loss is greater than 91 dB. 14. A patient who is breastfeeding is being scheduled for a gallium scan. What should the nurse advise the patient prior to scheduling the procedure? 1. Recommend complete cessation of breastfeeding after administration of Ga-67 2. Explain that they can continue breastfeeding 6 hours after administration of Ga-67 3. Recommend pumping and storing milk for 24 hours before giving to the infant 4. Explain that you don’t recommend the procedure for breastfeeding patients ANS: 1 Page: 620 Body System: Multisystem Feedback 1. This is correct. Explain to the patient who is breastfeeding that due to the large amount of radionuclide that passes into breast milk, complete cessation of breastfeeding is recommended after administration of Ga-67. Discuss alternative strategies for feeding the infant. 8 Van Leeuwen 9e Test Bank 2. This is incorrect. Complete cessation of breastfeeding is recommended. Elimination of the radionuclide from the body occurs between 6 to 24 hours after administration. 3. This is incorrect. Pumping and storing milk is not safe immediately after administration of Ga-67. 4. This is incorrect. Breastfeeding patients can safely undergo a gallium scan if they take the proper precautions and do no breastfeed following administration of Ga-67. 15. A nurse notes that a patient’s laboratory results show an acetylcholine receptor antibody (AChR) of 2.46 nmol/L. Based on this information, the nurse should assess this patient for clinical manifestations of: 1. malignant hyperprexia. 2. myasthenia gravis. 3. multiple myeloma. 4. muscular dystrophy. ANS: 2 Page: 1 Body System: Musculoskeletal system Feedback 1. This is incorrect. Malignant hyperprexia is a complication of general anesthesia, and is not a manifestation of elevated AChR. 2. This is correct. The nurse should assess the patient with an increased AChR level for clinical manifestations of myasthenia gravis because the muscle weakness associated with this disease is related to destruction of acetylcholine receptor sites. 3. This is incorrect. Multiple myeloma is assessed using albumin levels, and not AChR. 4. This is incorrect. Muscular dystrophy is assessed using aldolase levels, and not AChR. 16. A patient is suspected of having increased risk for stroke. Which type of angiography should be performed to detect this condition? 1. Abdominal 2. Adrenal 3. Carotid 4. Coronary ANS: 3 Page: 64 Body System: Circulatory system, nervous system Feedback 1. This is incorrect. Abdominal angiography is used to visualize and assess 9 Van Leeuwen 9e Test Bank abdominal organs/structure for tumor, infection, or aneurysm. 2. This is incorrect. Adrenal angiography is used to visualize and assess the adrenal gland for cancer or other tumors or masses, such as pheochromocytoma. 3. This is correct. Carotid angiography is used to visualize and assess the carotid arteries and surrounding tissues for abscess, tumors, and aneurysm and to evaluate for atherosclerotic disease related to stroke risk. 4. This is incorrect. Coronary angiography is used to visualize and assess the heart and surrounding structures for abnormalities, defects, aneurysm, and tumors and to diagnose coronary artery disease. 17. Which factor in a patient’s history may be associated with a decreased creatine kinase (CK) level? 1. Sedentary lifestyle 2. Alcoholism 3. Hypothyroidism 4. Surgery ANS: 1 Page: 432 Body System: Circulatory system, musculoskeletal system Feedback 1. This is correct. Sedentary lifestyle is associated with a decreased CK level due to decreased muscle mass. 2. This is incorrect. Alcoholism is associated with an increased CK level. 3. This is incorrect. Hypothyroidism is associated with an increased CK level. 4. This is incorrect. Surgery is associated with an increased CK level. 18. A nurse is preparing to administer a radionuclide to an adult patient for a gastroesophageal reflux scan. With what should the nurse mix the radionuclide? 1. Orange juice 2. Milk 3. Water 4. Soda ANS: 1 Page: 630 Body System: Digestive system Feedback 1. This is correct. The radionuclide is ingested orally in orange juice, and scanning studies are done immediately to assess the amount of liquid that has reached the stomach. 2. This is incorrect. The nurse should mix the radionuclide with orange juice, not milk. 10 Van Leeuwen 9e Test Bank 3. This is incorrect. The nurse should mix the radionuclide with orange juice, not water. 4. This is incorrect. The nurse should mix the radionuclide with orange juice, not soda. 19. A patient is suspected of having multiple myeloma and needs to undergo testing to identify the individual types of immunoglobulins present to confirm a diagnosis. Which test would be most appropriate for this purpose? 1. Immunofixation electrophoresis (IFE) 2. Immunoglobulin E (IgE) 3. Immunoglobulin A (IgA) 4. Immunosuppressant cyclosporine [CA = ciclosporine] ANS: 1 Page: 743 Body System: Immune system Feedback 1. This is correct. IFE is used to identify the individual types of immunoglobulins, to aid in diagnosing diseases such as multiple myeloma, and to evaluate effectiveness of chemotherapy 2. This is incorrect. IgE testing is used to assess IgE levels to identify the presence of an allergic or inflammatory immune response, such as in hay fever. 3. This is incorrect. IgA testing is used to evaluate patients suspected of IgA deficiency prior to transfusion and to evaluate anaphylaxis associated with the transfusion of blood and blood products (anti-IgA antibodies may develop in patients with low levels of IgA, possibly resulting in anaphylaxis when donated blood is transfused). 4. This is incorrect. Testing of the immunosuppressant cyclosporine [CA = ciclosporine] is done to assist in the management of treatments to prevent organ rejection and to monitor for toxicity. 20. A patient with a history of hypertension has a serum creatinine level of 1.9 mg/dL (SI = 168 micromol/L). When assessing this patient, a nurse should interpret these results as an indication this patient may have: 1. early signs of renal insufficiency. 2. evidence of severe kidney dysfunction. 3. hypertension secondary to kidney disease. 4. normal kidney function. ANS: 1 Page: 435 Body System: Musculoskeletal system, urinary system Feedback 1. This is correct. The nurse should interpret these results as an indication that the 11 Van Leeuwen 9e Test Bank patient may have early signs of renal insufficiency. 2. This is incorrect. Kidney disease is present at levels greater than 3 mg/dL. 3. This is incorrect. Although hypertension may result from renal insufficiency, additional testing is needed to confirm hypertension. 4. This is incorrect. Serum creatinine levels are elevated and indicate early signs of renal insufficiency. 21. A patient who is treated in an emergency department following a sexual assault is concerned about the possibility of infection with HIV. The patient requests a blood test to determine whether HIV infection has occurred. The results are negative. Which action by the nurse is appropriate? 1. Inform the patient to monitor for symptoms because false-negative results are common. 2. Instruct the patient to schedule a follow-up test in 6 months. 3. Reassure the patient that no infection with HIV has occurred. 4. Reinforce the need to use appropriate protection with intercourse in the future. ANS: 2 Page: 729 Body System: Circulatory/hematopoietic system, immune system Feedback 1. This is incorrect. False-positive HIV test results can occur in patients who are immunocompromised due to conditions that include autoimmune disease, leukemias, and lymphomas. 2. This is correct. The initial test establishes the patient’s current HIV status. If this is negative, the most appropriate action is for the nurse to instruct the patient to schedule a follow-up test in 6 months because it takes that long for the body to develop antibodies that can be detected. 3. This is incorrect. Negative HIV test results occur during the acute state of the disease, so the patient should schedule a follow-up test in 6 months. 4. This is incorrect. The nurse should not assume infection with HIV and should suggest a follow-up test in 6 months. 22. A patient maintained on furosemide is admitted with a serum potassium level of 2.9 mEq/L (SI = 2.9 mmol/L). Which clinical manifestation should the nurse expect to find on assessment? 1. Irritability and diarrhea 2. Malaise, thirst, polyuria, and low blood pressure 3. Oliguria and difficulty speaking 4. Cardiac dysrhythmias ANS: 2 Page: 989 Body System: Circulatory system, circulatory/hematopoietic system, digestive system, endocrine system, respiratory system, urinary system 12 Van Leeuwen 9e Test Bank Feedback 1. This is incorrect. Irritability and diarrhea are signs of hyperkalemia, not hypokalemia. 2. This is correct. The nurse should assess the patient for signs of hypokalemia, such as muscle weakness, lethargy, or irregular heartbeat. While hypokalemia may be asymptomatic, it is especially important to monitor the patient’s cardiac status. 3. This is incorrect. Oliguria and difficulty speaking are signs of hyperkalemia, not hypokalemia. 4. This is incorrect. Cardiac dysrhythmias are signs of hyperkalemia, not hypokalemia. 23. A patient’s laboratory test results indicate a negative finding on an infectious mononucleosis screen. The HCP, however, is concerned that this result could be a false-negative due to an interfering factor. Which of the following could cause such a false-negative finding? 1. Narcotic addition 2. Lymphoma 3. Hepatitis 4. Test conducted fewer than 6 days after exposure to the virus ANS: 4 Page: 873 Body System: Immune system Feedback 1. This is incorrect. Narcotic addiction may cause a false-positive finding. 2. This is incorrect. Lymphomas may result in a false-positive finding. 3. This is incorrect. Hepatitis may result in a false-positive finding. 4. This is correct. A false-negative result may occur if treatment was begun before antibodies developed or if the test was done less than 6 days after exposure to the virus. False-positive results may occur in the presence of narcotic addiction, serum sickness, lymphomas, hepatitis, leukemia, cancer of the pancreas, and phenytoin therapy. 24. A high school student is undergoing a required annual sports physical screening examination. A nurse notes that the student’s serum creatinine level is 1.3 mg/dL (SI = 114.9 micromol/L). Which additional laboratory data should the nurse consider in order to assess the significance of this result? 1. Albumin level 2. Blood urea nitrogen (BUN) 3. Hgb level 4. Triglyceride level ANS: 2 13 Van Leeuwen 9e Test Bank Page: 436 Body System: Musculoskeletal system, urinary system Feedback 1. This is incorrect. Albuminuria is considered an independent risk factor predictive of kidney or cardiovascular disease and is not related to the serum creatinine level. 2. This is correct. The ratio of serum creatinine to BUN is important when interpreting the significance of the result. 3. This is incorrect. Hgb levels would be used to assess fluid volume excess. 4. This is incorrect. Triglyceride levels are related to total cholesterol levels, and not serum creatinine. 25. A patient has an order for a blood test for antisperm antibodies. Which condition should a nurse plan to manage if this test is positive? 1. Infertility 2. Prostate cancer 3. Prostatic hyperplasia 4. Testicular cancer ANS: 1 Page: 99 Body System: Immune system, reproductive system Feedback 1. This is correct. The nurse should plan to provide infertility counseling because the test is used to identify the presence of antibodies that lower the sperm count over time. 2. This is incorrect. Prostate cancer is not identified using antisperm antibodies. 3. This is incorrect. Prostatic hyperplasia is not identified using antisperm antibodies 4. This is incorrect. Although high levels of antisperm antibodies may result from the disruption in the integrity of the blood-testes barrier in testicular cancer, more testing is needed to confirm a diagnosis. 26. A patient diagnosed with chronic obstructive pulmonary disease has a carboxyhemoglobin level of 5% (percent saturation of hemoglobin). When planning care for this patient, which question should a nurse ask to determine the significance of this result? 1. “Do you experience headaches or dizziness?” 2. “How many cigarettes do you smoke each day?” 3. “How often do you exercise outdoors?” 4. “What kind of heating do you have in your home?” ANS: 2 Page: 286 Body System: Respiratory system 14 Van Leeuwen 9e Test Bank Feedback 1. This is incorrect. Headaches and dizziness occur at levels of 10% to 30% of total hemoglobin. 2. This is correct. The nurse should ask about smoking habits because smokers can have carboxyhemoglobin levels up to 10%. 3. This is incorrect. Exercising outdoors will not influence carboxyhemoglobin levels. 4. This is incorrect. Although this question is important because gas heaters and indoor cooking fires may influence CO levels, the most relevant question to ask is related to cigarette smoking. 27. A patient with a history of sickle cell disease has a total bilirubin level of 0.9 mg/dL (SI = 15.4 micromol/L) with a direct bilirubin level of 0.3 mg/dL (SI = 5.1 micromol/L). Which additional data should the nurse obtain to plan care for this patient? 1. None, normal results 2. Ultrasound of the gallbladder 3. Liver function tests 4. Serum electrolytes ANS: 1 Page: 142 Body System: Digestive system Feedback 1. This is correct. Destruction of red blood cells during a sickle cell crisis could increase bilirubin, but these results are within normal limits (less than 1.2 mg/dL), so no additional information is needed. 2. This is incorrect. Total bilirubin levels are within normal limits, so no additional information is needed. 3. This is incorrect. Total bilirubin levels are within normal limits, so no additional information is needed. 4. This is incorrect. Total bilirubin levels are within normal limits, so no additional information is needed. 28. A nurse assessing a patient with a history of inflammatory bowel disease notes bilateral pitting edema of both the ankles and feet. Which laboratory result is most likely related to this finding? 1. Decreased albumin 2. Elevated triglycerides 3. Elevated cholesterol 4. Elevated platelet count ANS: 1 Page: 16 Body System: Digestive system, urinary system 15 Van Leeuwen 9e Test Bank Feedback 1. This is correct. Because proteins in the blood maintain the osmotic pressure gradient that keeps water in the vascular spaces, the nurse should observe for decreased albumin that will contribute to the movement of water from the vascular to the interstitial spaces. 2. This is incorrect. Elevated triglycerides would not lead to pitting edema of the ankles and feet. 3. This is incorrect. Elevations of cholesterol are associated with conditions caused by an inherited defect in lipoprotein metabolism, liver disease, kidney disease, or a disorder of the endocrine system 4. This is incorrect. An elevated platelet count, or thrombocytosis, may cause increased clotting and would not lead to pitting edema in the ankles and feet. 29. A patient diagnosed with coronary artery disease begins therapy with simvastatin. Which laboratory result should the nurse monitor to determine the effectiveness of this treatment? 1. Aspartate aminotransferase 2. Alkaline phosphatase 3. Alanine aminotransferase 4. Total cholesterol ANS: 4 Page: 343 Body System: Circulatory system Feedback 1. This is incorrect. Aspartate aminotransferase is used to assess liver function and would not be affected by simvastatin. 2. This is incorrect. Alkaline phosphatase is used to assess liver function and would not be affected by simvastatin. 3. This is incorrect. Alanine aminotransferase is used to assess liver function and would not be affected by simvastatin. 4. This is correct. Statins such as simvastatin inhibit a liver enzyme, HMG Co-A reductase, reducing the liver’s ability to make cholesterol. This results in a significant decrease in low-density lipoprotein “bad” cholesterol levels, so the nurse should monitor total cholesterol to determine the patient’s response to treatment. 30. A patient with a serum phosphate level of 1.1 mg/dL (SI = 0.4 mmol/L) is receiving IV sodium phosphate. When administering sodium phosphate, a nurse should monitor closely for: 1. convulsions, nervousness, and muscle cramps. 2. lethargy and confusion. 3. nausea, vomiting, and diarrhea. 4. headaches and anorexia. ANS: 1