Question Set A: Ranges, Directions, and the Call
A compact two-column monospace data card with a heavy border and offset shadow carrying six analyte rows, two draw columns, and a delta column, with all flags deliberately omitted so the candidate must decide which rows matter.
SERIAL PANEL CARD · shared stimulus for items 6 and 8
| Analyte | Draw 1, Monday 0600 | Draw 2, Tuesday 0600 | Δ |
|---|---|---|---|
| Sodium | 139 mEq/L | 141 mEq/L | +2 |
| Potassium | 4.0 mEq/L | 2.9 mEq/L | −1.1 |
| Chloride | 103 mEq/L | 99 mEq/L | −4 |
| Magnesium | 1.9 mEq/L | 1.4 mEq/L | −0.5 |
| BUN | 16 mg/dL | 26 mg/dL | +10 |
| Creatinine | 0.9 mg/dL | 1.2 mg/dL | +0.3 |
Item 1. A client's serum potassium this morning is 6.1 mEq/L. Yesterday's value was 4.8 mEq/L. Which action does the nurse take first?
- Notify the provider of the result.
- Obtain a 12-lead electrocardiogram.
- Review the medication record for potassium-containing preparations.
- Send a repeat specimen to rule out hemolysis.
☐ ______________________________________________
Item 2. A client's total serum calcium is 7.2 mg/dL and the albumin is 4.1 g/dL. Which findings does the nurse expect? Select all that apply.
- Tingling around the mouth and in the fingertips
- A positive Trousseau sign when the blood pressure cuff is inflated
- Constipation and bone pain
- Hyperactive deep tendon reflexes
- Lethargy and generalized muscle weakness
- Carpopedal spasm
☐ ______________________________________________
Item 3. A client receiving chemotherapy has a white blood cell count of 2,400/mm³ and an absolute neutrophil count of 320/mm³. Which action does the nurse take?
- Place the client in a private room and institute neutropenic precautions.
- Continue standard precautions, since the white blood cell count is above 2,000/mm³.
- Place the client in a negative-pressure room on airborne precautions.
- Restrict the client to bed rest and check the temperature once daily.
☐ ______________________________________________
Item 4. The laboratory telephones a critical magnesium of 0.8 mEq/L. Place the nurse's actions in the order they should occur.
- (a) Notify the provider.
- (b) Recheck the level as ordered.
- (c) Confirm the result belongs to this client.
- (d) Read the value back to the provider and document the read-back with the time.
- (e) Assess the client, including deep tendon reflexes and respiratory rate.
☐ ______________________________________________
Item 5. A client is admitted with three days of watery diarrhea. For each result, mark whether it is an expected finding for this client, an unexpected finding, or a critical value requiring notification.
| Result | Expected | Unexpected | Critical |
|---|---|---|---|
| Potassium 3.1 mEq/L | ☐ | ☐ | ☐ |
| Bicarbonate 18 mEq/L | ☐ | ☐ | ☐ |
| Sodium 119 mEq/L | ☐ | ☐ | ☐ |
| Total calcium 12.8 mg/dL | ☐ | ☐ | ☐ |
Item 6. Using the serial panel card above, which analyte requires nursing action first?
- Sodium
- Potassium
- Magnesium
- Creatinine
☐ ______________________________________________
Item 7. A client takes digoxin once daily. The morning results are a digoxin level of 2.4 ng/mL, a creatinine of 1.9 mg/dL, and a potassium of 3.2 mEq/L. What is the nurse's response?
- Give the dose and recheck the level in the morning.
- Hold the dose, assess the apical pulse for one full minute, and notify the provider of all three values.
- Give the dose and encourage foods high in potassium.
- Hold the dose and repeat the level after the next scheduled dose is given.
☐ ______________________________________________
Item 8. Using the serial panel card above, which findings require the nurse to notify the provider before the next scheduled medications are given? Select all that apply.
- Potassium 2.9 mEq/L
- Sodium 141 mEq/L
- Magnesium 1.4 mEq/L
- BUN 26 mg/dL
- Chloride 99 mEq/L
- Creatinine 1.2 mg/dL
☐ ______________________________________________
Margin notecover the rationale page first.
→ BOOK 07 · P13 for the answers, after you have written yours.
Takeawayif you cannot name the action, knowing the range was not enough.
Items are keyed to a single study standard. Reference ranges vary between institutions and reference laboratories. Follow local protocol.