Chapter 1

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____	1.	A patient’s laboratory test results indicate an elevated blood glucose level. The nurse understands that this finding most likely indicates dysfunction of which associated organ?
1.	Kidney	
2.	Pancreas	
3.	Stomach	
4.	Spleen	

____	2.	A patient’s laboratory test results indicate a low creatinine level. The nurse should most suspect dysfunction of which organ based on these findings?
1.	Kidney	
2.	Pancreas	
3.	Liver	
4.	Spleen	

____	3.	An older patient complains of lack of appetite in the past year. The nurse knows that deficiency in which of the following could explain this finding?
1.	Electrolytes	
2.	Hormones	
3.	Vitamins	
4.	Minerals	

____	4.	A nurse is explaining the venipuncture process to a patient. How long should the nurse tell the patient that it will take to perform venipuncture?
1.	1 to 2 minutes	
2.	5 to 10 minutes	
3.	10 to 15 minutes	
4.	15 to 20 minutes	

____	5.	A nurse has just completed venipuncture on a patient. What should the nurse do to prevent bleeding and bruising?
1.	Administer an anticoagulant.	
2.	Apply an antibiotic ointment to the site.	
3.	Have the patient lie down.	
4.	Apply direct pressure to the site with gauze.	

____	6.	A patient is suspected of having liver disease. Which of the following tests would be most appropriate for confirming this suspicion?
1.	Cholesterol	
2.	Alanine aminotransferase	
3.	Carbon dioxide	
4.	Blood chloride	

____	7.	A patient’s laboratory test results indicate an increased blood albumin level. The nurse is aware that this finding is consistent with which of the following conditions?
1.	Cirrhosis	
2.	Dehydration	
3.	Bacterial infection	
4.	Burns	

____	8.	The nurse is preparing to draw blood for testing of albumin level. The nurse should be aware that which of the following factors can cause a falsely elevated result?
1.	Upright posture	
2.	Exercise just before collection	
3.	Carbohydrate intake	
4.	Anxiety	

____	9.	A nurse is performing venipuncture on an elderly patient. Which of the following complications should the nurse be especially careful to monitor for, as it occurs more frequently in elderly or frail patients?
1.	Cellulitis	
2.	Phlebitis	
3.	Hematoma	
4.	Sepsis	

____	10.	A patient’s laboratory test results indicate elevated blood amylase. The nurse understands that this finding is most likely associated with damage to cells of which of the following?
1.	Spleen	
2.	Pancreas	
3.	Liver	
4.	Kidney	

____	11.	A nurse is providing nutritional counseling to a patient with increased amylase level and gastrointestinal disease. The patient’s acute symptoms have subsided and bowel sounds have returned. What type of diet should the nurse recommend to the patient?
1.	Soft diet progressing to a low-carbohydrate, high-protein diet	
2.	Low-calorie diet progressing to a low-fat, high-carbohydrate diet	
3.	Bland diet progressing to a low-carbohydrate, high-protein diet	
4.	Clear liquid diet progressing to a low-fat, high-carbohydrate diet	

____	12.	A patient is currently taking vancomycin to treat a staph infection. The nurse should monitor the level of which of the following every 2 to 3 days in this patient, to detect renal impairment due to toxic drug levels?
1.	Creatinine	
2.	Glucose	
3.	Amylase	
4.	White blood cell count	

____	13.	A nurse is preparing to administer a first dose of an aminoglycoside to a patient. Which of the following should the nurse do in connection with this action?
1.	Explain that the patient may discontinue medication as soon as symptoms disappear.	
2.	Obtain a culture before and after administration of the drug.	
3.	Use serum separator tubes (gel tubes) to draw blood.	
4.	Administer a penicillin first.	

____	14.	A nurse is monitoring a patient who is taking an antibiotic for signs of toxic levels. Which of the following should the nurse assess for?
1.	Loss of consciousness	
2.	Loss of sensation	
3.	Loss of sight	
4.	Loss of hearing	

____	15.	A nurse is providing counsel to a pregnant patient with epilepsy who is taking the anti-seizure medication phenobarbital. Which vitamin should the nurse urge the patient to take during her pregnancy to help prevent neural tube defects?
1.	Ascorbic acid	
2.	Folic acid	
3.	Riboflavin	
4.	Niacin	

____	16.	A nurse is working with a patient on an antidepressant who is a poor metabolizer. The nurse should monitor this patient for which of the following?
1.	Drug-induced side effects due to accumulation of the drug in the blood	
2.	A need for a higher-than-normal dose of the medication for efficacy	
3.	An anaphylactic response to the medication	
4.	Signs of drug dependence	

____	17.	A nurse is reviewing a patient’s laboratory results, which indicate the current blood level of the cyclic antidepressant amitriptyline. Which of the following represents the drug level above which the nurse should immediately report the results to the requesting health-care provider as a critical finding?
1.	250 ng/mL	
2.	500 ng/mL	
3.	750 ng/mL	
4.	1000 ng/mL	

____	18.	A patient’s laboratory test results indicate an aspartate aminotransferase (AST) level four times normal levels. The nurse should most suspect which of the following conditions in this patient?
1.	Acute pancreatitis	
2.	Cirrhosis	
3.	Cerebrovascular accident	
4.	Hemolytic anemia	

____	19.	A patient’s laboratory test results indicate an aspartate aminotransferase (AST) level seven times normal. The nurse should most suspect which of the following conditions in this patient?
1.	Acute pancreatitis	
2.	Cirrhosis	
3.	Cerebrovascular accident	
4.	Hemolytic anemia	

____	20.	A nurse is caring for a patient who is on hemodialysis. Which of the following laboratory test results should the nurse expect in this patient in terms of aspartate aminotransferase (AST) level?
1.	Significantly increased	
2.	Moderately increased	
3.	Slightly increased	
4.	Decreased	

____	21.	A patient’s laboratory test results indicate an elevated bilirubin level. Which of the following associated symptoms should the nurse expect to see in this patient?
1.	Pallor	
2.	Cyanosis	
3.	Hyperemia	
4.	Jaundice	

____	22.	A patient’s laboratory test results indicate low calcium levels. The nurse knows that the most common cause of hypocalcemia is which of the following?
1.	Hypoalbuminemia	
2.	Hyperparathyroidism	
3.	Cancer	
4.	Acromegaly	

____	23.	A nurse is preparing to draw blood samples of a patient for testing of calcium level. The nurse should be aware that which of the following is a factor that affects blood calcium level?
1.	Patient’s posture	
2.	Time of day the sample is collected	
3.	Anxiety	
4.	Recent exercise	

____	24.	A physician has ordered a total carbon dioxide test for a patient. The nurse knows that the most likely purpose for this test is the evaluation of which of the following?
1.	Blood glucose	
2.	Lipids	
3.	Acid-base balance	
4.	Pathogenic organisms	

____	25.	A patient’s blood chloride levels are elevated. The nurse should thus expect to find which of the following in this patient?
1.	Increased sodium, decreased bicarbonate	
2.	Decreased sodium, increased bicarbonate	
3.	Increased sodium, increased bicarbonate	
4.	Decreased sodium, decreased bicarbonate	

____	26.	A nurse is preparing to draw blood for cholesterol testing. The nurse should first make sure that the patient has fasted from food for at least how many hours?
1.	4	
2.	8	
3.	12	
4.	16	

____	27.	A patient has just been found to have high total and low-density lipoprotein (LDL) cholesterol levels. Based on 2013 guidelines for the prevention of cardiovascular disease developed by the American College of Cardiology (ACC) and the American Heart Association (AHA), the nurse should expect the physician to make which of the following recommendations to the patient?
1.	Determination of treatment based on the elevated LDL level	
2.	Prescription of a statin, based on being in one of four at-risk groups	
3.	Use of a standard dosage of statin recommended by the AHA	
4.	A diet low in cholesterol	

____	28.	A nurse is providing teaching to a client whose total cholesterol level is elevated. Based on guidelines from the National Cholesterol Education Program, the nurse should recommend that the patient maintain a total cholesterol level of less than which of the following?
1.	100 mg/dL	
2.	150 mg/dL	
3.	200 mg/dL	
4.	250 mg/dL	

____	29.	A nurse is drawing blood from a patient for C-reactive protein (CRP) testing. The nurse understands that this patient is likely being assessed for which of the following conditions?
1.	Type 2 diabetes	
2.	Alzheimer’s disease	
3.	Coronary artery disease	
4.	Lung cancer	

____	30.	A nurse is preparing a patient to undergo venipuncture for C-reactive protein (CRP) testing. The nurse should be aware that which of the following factors is most likely to lead to a false-negative result?
1.	Presence of an intrauterine device	
2.	Use of NSAIDs	
3.	Chemotherapy	
4.	Smoking	

____	31.	A nurse is performing venipuncture on a patient to obtain a specimen for creatine kinase (CK) testing. The patient is suspected of having had a myocardial infarction (MI). The nurse knows that if an MI has occurred, the isoenzyme CK-MB level will be at its peak how many hours following the event?
1.	12 hours	
2.	24 hours	
3.	48 hours	
4.	72 hours	

____	32.	A patient’s laboratory test results indicate elevated isoenzyme creatine kinase (CK)-BB level. The nurse should most suspect which of the following conditions based on this finding?
1.	Brain infarction	
2.	Congestive heart failure	
3.	Muscular dystrophy	
4.	Gastrointestinal tract infarction	

____	33.	A patient’s laboratory test results indicate decreased creatine kinase (CK) level. The nurse should most suspect which of the following conditions based on this finding?
1.	Brain infarction	
2.	Sedentary lifestyle	
3.	Muscular dystrophy	
4.	Gastrointestinal tract infarction	

____	34.	A patient is undergoing a creatinine clearance test. The nurse understands that this test measures which of the following?
1.	Coagulation rate	
2.	Glomerular filtration rate	
3.	Metabolism rate	
4.	Gastric emptying rate	

____	35.	A nurse is reviewing a patient’s blood glucose test results. The nurse knows that two instances on subsequent days of fasting blood glucose level greater than which of the following, after a minimum of an 8-hour fast, is indicative of diabetes?
1.	99 mg/dL	
2.	126 mg/dL	
3.	174 mg/dL	
4.	201 mg/dL	

____	36.	A patient with diabetes needs to undergo testing to monitor his insulin treatment and evaluate his long-term glycemic control. The nurse should anticipate which of the following tests for this patient?
1.	Glucose	
2.	Creatinine	
3.	C-reactive protein	
4.	Glycated hemoglobin	

____	37.	A nurse is providing teaching to a patient who is preparing to undergo glycated hemoglobin testing. The nurse should explain to the patient that this test will assist in evaluating blood sugar control over approximately how many months?
1.	1 month	
2.	2 months	
3.	3 months	
4.	4 months	

____	38.	A patient is in her seventh week of pregnancy. Reviewing this patient’s laboratory test results, the nurse observes that the patient’s human chorionic gonadotropin (HCG) levels have decreased significantly. The nurse is aware that this finding is most consistent with which of the following?
1.	Malignant tumor	
2.	Multiple gestation pregnancy	
3.	Healthy pregnancy	
4.	Ectopic pregnancy	

____	39.	A nurse is working with a patient who has been prescribed methotrexate. When reviewing the patient’s health history, which of the following should the nurse report to the requesting health-care provider as a contraindication for this treatment for the patient?
1.	Rheumatoid arthritis	
2.	Heart disease	
3.	Liver disease	
4.	Breast cancer	

____	40.	A patient’s laboratory test results indicate an elevated lipase level. The nurse should expect damage to or disease of which of the following organs?
1.	Heart	
2.	Lungs	
3.	Pancreas	
4.	Stomach	

____	41.	A nurse is preparing to perform venipuncture on a patient for lipase testing. The nurse should be aware that which of the following factors can artificially increase blood lipase levels?
1.	Exercise	
2.	Hemodialysis	
3.	Smoking	
4.	Magnetic resonance imaging	

____	42.	A patient’s laboratory test results indicate decreased lipase levels. The nurse should expect an order to administer which of the following vitamins to this patient?
1.	B12	
2.	C	
3.	D	
4.	K	

____	43.	A patient’s laboratory test results indicate an elevated serum myoglobin level. The nurse understands that this finding would be most likely to be associated with which of the following?
1.	Pancreatitis	
2.	Myasthenia gravis	
3.	Heart attack	
4.	Rheumatoid arthritis	

____	44.	A patient with a history of substance abuse is found to have an elevated serum myoglobin level. The nurse should suspect abuse of which of the following substances?
1.	Marijuana	
2.	Cocaine	
3.	Alcohol	
4.	Methamphetamine	

____	45.	A nurse performs early hearing loss detection and intervention testing (EHDI) on an infant. The nurse is aware that the goal of EHDI is to assure that permanent hearing loss is detected before which age?
1.	3 months	
2.	6 months	
3.	9 months	
4.	12 months	

____	46.	A newborn with signs of failure to thrive, salty sweat, thick mucus, recurring sinus infections, and chronic diarrhea is preparing to undergo newborn screening. Which specific test should the nurse anticipate being included in the screening related to these symptoms?
1.	Hemoglobin electrophoresis	
2.	Amino acid screening	
3.	Sweat electrolyte	
4.	Galactose-1-phosphate level	

____	47.	A patient’s laboratory test results indicate increased serum parathyroid hormone (PTH) level. The nurse should expect that this finding is associated with a decreased level of which of the following?
1.	Sodium	
2.	Magnesium	
3.	Potassium	
4.	Calcium	

____	48.	A patient’s laboratory test results indicate decreased serum parathyroid hormone (PTH) level. The nurse should assess the patient for which of the following conditions?
1.	Pseudogout	
2.	Sarcoidosis	
3.	Primary hyperparathyroidism	
4.	Zollinger-Ellison syndrome	

____	49.	A nurse has just collected a blood specimen for parathyroid hormone (PTH) testing. Which of the following actions should the nurse take next?
1.	Protect the specimen from exposure to light by placing it in a special pouch.	
2.	Place the specimen in an ice slurry for transport.	
3.	Refrigerate the specimen.	
4.	Allow the specimen to sit for an hour to facilitate settling.	

____	50.	A nurse learns that a patient’s potassium level is unexpectedly elevated and suspects a false result. Which of the following factors would best explain such a result?
1.	An unprocessed sample was left at room temperature.	
2.	The patient smoked immediately before blood collection.	
3.	The patient takes an aspirin daily.	
4.	The specimen was exposed to direct sunlight.	

____	51.	A patient’s laboratory test results indicate a decreased prealbumin level. The nurse should expect a corresponding deficiency in which of the following vitamins?
1.	A	
2.	B12	
3.	C	
4.	D	

____	52.	A nurse is providing instructions to a patient who will undergo venipuncture at her next office visit for prealbumin testing. The nurse should instruct the patient to fast for at least how many hours before the procedure?
1.	2 hours	
2.	4 hours	
3.	6 hours	
4.	8 hours	

____	53.	A nurse is assessing a vegetarian patient who is demonstrating signs of malnutrition. The nurse is aware that which of the following is the protein present in the highest concentrations in the body?
1.	Globulin	
2.	Haptoglobin	
3.	Ceruloplasmin	
4.	Albumin	

____	54.	A nurse is reviewing a patient’s laboratory test results, which indicate that the patient’s total protein level is lower than normal. The nurse suspects, however, that the results may be inaccurate. Which of the following factors could explain this test result?
1.	Hemolysis occurring during the procedure	
2.	The patient being recumbent during venipuncture	
3.	The tourniquet being left on the arm for 2 minutes	
4.	The patient being on anabolic steroids	

____	55.	A patient must undergo testing to monitor the effect of diuretic use. Which test should the nurse anticipate the patient undergoing?
1.	Magnesium	
2.	Calcium	
3.	Sodium	
4.	Potassium	

____	56.	A diabetic patient’s laboratory test results indicate an elevated sodium level. The nurse understands that the test result is associated with the patient’s diabetes because of which of the following factors?
1.	Dehydration related to frequent urination	
2.	Excessive intake related to a high-sodium diet	
3.	Excessive production of aldosterone related to an increased glucose level	
4.	Hemoconcentration related to excessive sweating	

____	57.	A nurse is administering intravenous saline for replacement in a patient who is hyponatremic. Which of the following should the nurse be most concerned about monitoring during this procedure?
1.	Blood glucose level	
2.	Heart rate and rhythm	
3.	Respiratory rate	
4.	Serum and urine osmolality	

____	58.	A 10-year-old boy is showing signs of early puberty, including rapid growth, the appearance of pubic hair, and a deepening voice. A laboratory test result indicates an elevated testosterone level. The nurse understands that which of the following conditions would best explain this phenomenon?
1.	Klinefelter’s syndrome	
2.	Testicular tumor	
3.	Cryptorchidism	
4.	Primary hypopituitarism	

____	59.	An elite female college athlete demonstrates a decreased testosterone level. The nurse should assess for which of the following conditions, most likely connected to this finding?
1.	Ovarian tumor	
2.	Adrenal hyperplasia	
3.	Anovulation	
4.	Hyperthyroidism	

____	60.	A patient’s laboratory test results indicate an elevated thyroid-stimulating hormone (TSH) level and a decreased thyroxine (T4) level. The nurse should most suspect which of the following conditions?
1.	Hypothyroidism related to a congenital defect in T4-binding globulin	
2.	Transient congenital hypothyroidism owing to hypoxia	
3.	Hypothyroidism related to a dysfunctional thyroid gland	
4.	Secondary congenital hypothyroidism and pituitary hypothalamic dysfunction	

____	61.	A patient’s laboratory test results indicate a decreased thyroid-stimulating hormone (TSH) level. The nurse should assess this patient for which of the following conditions associated with this finding?
1.	Graves’ disease	
2.	Klinefelter’s syndrome	
3.	Down syndrome	
4.	Turner syndrome	

____	62.	A nurse is preparing to review a patient’s laboratory test results related to free thyroxine (T4) level. The patient is in her 38th week of pregnancy. Which of the following results related to free T4 level should the nurse anticipate for this patient?
1.	Normal	
2.	Increased	
3.	Decreased	
4.	Absent	

____	63.	A patient’s laboratory test results indicate an increased free thyroxine (T4) level, but the nurse suspects that this is falsely elevated. Which of the following medications could cause this result?
1.	Anabolic steroids	
2.	Methadone	
3.	Oral contraceptives	
4.	Aspirin	

____	64.	Throughout a day at the community clinic, a nurse performs blood tests on a variety of patients. Which of the following patients should the nurse most expect to have elevated triglyceride levels?
1.	A 65-year-old African American man with diabetes	
2.	A 25-year-old Hispanic woman who takes oral contraceptives	
3.	A 65-year-old white man who is obese	
4.	A 45-year-old African American woman with a history of breast cancer	

____	65.	A patient recently had a myocardial infarction and now must undergo testing to evaluate the resulting myocardial muscle damage. Which of the following tests should the nurse anticipate this patient undergoing?
1.	Triglycerides	
2.	Creatinine	
3.	Prealbumin	
4.	Troponins I and T	

____	66.	A nurse is obtaining a series of blood samples for troponins I and T testing from a patient who had a myocardial infarction (MI) 1 hour ago. The nurse should expect the troponin I level to peak initially how long after the MI?
1.	2 to 6 hours	
2.	15 to 24 hours	
3.	60 to 80 hours	
4.	7 days	

Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____	67.	A patient demonstrates an imbalance in electrolytes. Which of the following outcomes, associated with this condition, should the nurse assess for in this patient? Select all that apply.
1.	Acid–base balance	
2.	Elevated blood glucose	
3.	Disruption of osmosis	
4.	Elevated blood lipids	
5.	Muscle atrophy	

____	68.	A patient is hypersensitive about cholesterol in her diet and thinks that this lipid only does harm in the body. Which of the following should the nurse point out as necessary functions of cholesterol in the body? Select all that apply.
1.	Maintains acid-base balance	
2.	Helps form vitamin D	
3.	Catalyzes biochemical processes	
4.	Aids in digestion of fats	
5.	Serves as a component of myelin sheath	

____	69.	A patient’s fat intake is too low, resulting in deficiencies in several fat-soluble vitamins. Which of the following are fat-soluble vitamins, which the nurse should assess for deficiencies in? Select all that apply.
1.	Vitamin A	
2.	Vitamin B	
3.	Vitamin C	
4.	Vitamin D	
5.	Vitamin E	

____	70.	A nurse is obtaining patient identification before a procedure. Which of the following are acceptable unique identifiers? Select all that apply.
1.	Patient name	
2.	Date of birth	
3.	Home address	
4.	Social security number	
5.	Phone number	

____	71.	A patient’s laboratory test results indicate an elevated alanine aminotransferase level. The nurse understands that this finding is associated with which of the following conditions? Select all that apply.
1.	Chronic alcohol abuse	
2.	Hepatitis	
3.	Infectious mononucleosis	
4.	Pyridoxal phosphate deficiency	
5.	Myocardial infarction	

____	72.	A nurse is performing venipuncture on a patient. The patient has a history of vasovagal reactions during venipuncture. Which of the following signs of this reaction should the nurse look for in this patient? Select all that apply.
1.	High blood pressure	
2.	Fainting	
3.	Sweating	
4.	Seizure	
5.	Rash	

____	73.	A nurse is working with a patient who has a decreased blood albumin level. Which of the following are expected outcomes for this patient? Select all that apply.
1.	Agreeing to abstain from alcohol	
2.	Increasing extravascular fluid volume	
3.	Making nutritional selections that support a healthy body weight	
4.	Reducing carbohydrate intake	
5.	Engaging in regular exercise	

____	74.	A patient’s laboratory test results indicate an elevated alkaline phosphatase (ALP) level. The nurse understands that this finding is consistent with which of the following conditions? Select all that apply.
1.	Viral hepatitis	
2.	Healing fractures	
3.	Severe anemia	
4.	Osteogenic sarcoma	
5.	Celiac disease	

____	75.	A nurse is providing nutritional counseling to a patient who has an elevated alkaline phosphatase (ALP) level. Which of the following should the nurse encourage the patient to eat? Select all that apply.
1.	Homogenized milk	
2.	Rice	
3.	Eggs	
4.	Oat bran	
5.	Baked potato	

____	76.	A patient’s laboratory test results indicate an elevated blood amylase level. The nurse knows that this finding is associated with which of the following conditions? Select all that apply.
1.	Biliary tract disease	
2.	Ectopic pregnancy	
3.	Pancreatectomy	
4.	Parotitis	
5.	Toxemia of pregnancy	

____	77.	A nurse is working with a patient who is taking carbamazepine. The nurse should know that this medication is used for which of the following purposes? Select all that apply.
1.	Reducing the frequency and severity of seizures	
2.	Fighting off gram-negative bacteria	
3.	Controlling neurogenic pain in trigeminal neuralgia	
4.	Suppressing the immune system	
5.	Decreasing the blood cholesterol level	

____	78.	A nurse is monitoring a patient who is taking valproic acid. The nurse should be aware of and monitor for which of the following factors, which influence the drug’s action? Select all that apply.
1.	Patient attitude	
2.	Patient posture	
3.	Patient age	
4.	Patient weight	
5.	Patient protein levels	

____	79.	A nurse is working with a patient who is on a cyclic antidepressant. Besides major depression, the nurse understands that this patient may have been prescribed this medication for which of the following conditions? Select all that apply.
1.	Seizure disorder	
2.	Bipolar disorder	
3.	Panic disorder	
4.	Asperger disorder	
5.	Obsessive-compulsive disorder	

____	80.	A patient’s laboratory test results indicate prehepatic jaundice. The nurse should suspect which of the following as possible causes of this condition? Select all that apply.
1.	Hematoma	
2.	Hemolytic anemia	
3.	Alcoholism	
4.	Red blood cell enzyme abnormalities	
5.	Biliary obstruction	

____	81.	A patient’s laboratory test results indicate posthepatic jaundice. The nurse should suspect which of the following as possible causes of this condition? Select all that apply.
1.	Advanced tumors of the liver	
2.	Hemolytic anemia	
3.	Alcoholism	
4.	Red blood cell enzyme abnormalities	
5.	Biliary obstruction	

____	82.	A patient’s laboratory test results indicate an increased calcium level. The nurse knows that which of the following conditions could cause this finding? Select all that apply.
1.	Acute pancreatitis	
2.	Acidosis	
3.	Leukemia	
4.	Hepatic cirrhosis	
5.	Dehydration	

____	83.	A patient’s laboratory test results indicate an elevated blood carbon dioxide level. The nurse knows that this finding is consistent with which of the following conditions? Select all that apply.
1.	Acute renal failure	
2.	Airway obstruction	
3.	Pneumonia	
4.	High fever	
5.	Pulmonary tuberculosis	

____	84.	A patient’s laboratory test results indicate a decreased blood carbon dioxide level. The nurse knows that this finding is consistent with which of the following conditions? Select all that apply.
1.	Acute renal failure	
2.	Airway obstruction	
3.	Pneumonia	
4.	High fever	
5.	Pulmonary tuberculosis	

____	85.	A patient’s blood chloride levels are decreased. The nurse should suspect which of the following conditions? Select all that apply.
1.	Metabolic acidosis	
2.	Addison’s disease	
3.	Diabetic ketoacidosis	
4.	Primary hyperparathyroidism	
5.	Congestive heart failure	

____	86.	A patient’s blood chloride levels are increased. The nurse should suspect which of the following conditions? Select all that apply.
1.	Metabolic acidosis	
2.	Addison’s disease	
3.	Diabetic ketoacidosis	
4.	Primary hyperparathyroidism	
5.	Congestive heart failure	

____	87.	A patient’s laboratory test results indicate increased high-density lipoprotein (HDL) cholesterol level. The nurse should suspect which of the following conditions associated with this finding? Select all that apply.
1.	Alcoholism	
2.	Chronic renal failure	
3.	Chronic hepatitis	
4.	Obesity	
5.	Smoking	

____	88.	A patient’s laboratory test results indicate decreased high-density lipoprotein (HDL) cholesterol level. The nurse should suspect which of the following conditions associated with this finding? Select all that apply.
1.	Alcoholism	
2.	Chronic renal failure	
3.	Chronic hepatitis	
4.	Obesity	
5.	Smoking	

____	89.	A nurse is providing instructions to a patient who will be undergoing venipuncture for total cholesterol and triglyceride testing at the next appointment. Which of the following should the nurse tell the patient to do immediately before the procedure? Select all that apply.
1.	Refrain from exercise for 8 hours.	
2.	Fast for 6 to 12 hours.	
3.	Withhold alcohol for 12 to 24 hours.	
4.	Lie supine for 20 minutes.	
5.	Sit upright for 10 minutes.	

____	90.	A patient’s laboratory test results indicate an increase in C-reactive protein (CRP) level. The nurse is aware that this finding is associated with which of the following conditions? Select all that apply.
1.	Acute bacterial infection	
2.	Crohn’s disease	
3.	Sickle cell anemia	
4.	Myocardial infarction	
5.	Epilepsy	

____	91.	A patient’s laboratory test results indicate a decreased blood creatinine level. The nurse knows that this finding is most likely associated with which of the following? Select all that apply.
1.	Muscle atrophy	
2.	Hyperthyroidism	
3.	Pregnancy	
4.	Chronic renal failure	
5.	Shock	

____	92.	A nurse is preparing to perform venipuncture on a patient for creatinine testing. The nurse should be aware that which of the following factors might falsely increase the patient’s creatinine level and lead to an inaccurate result? Select all that apply.
1.	The patient went for a run 2 hours before collection.	
2.	The patient has a diet high in meat.	
3.	The patient is diabetic.	
4.	The patient has chronic renal failure.	
5.	The patient ate a meal 4 hours before collection.	

____	93.	A patient is suspected of having diabetes mellitus. Besides an elevated blood glucose level, the nurse should assess the patient for which of the following symptoms of this disease? Select all that apply.
1.	Increased urination	
2.	Loss of appetite	
3.	High blood pressure	
4.	Excessive thirst	
5.	Unexplained weight gain	

____	94.	A nurse is providing teaching to a patient who has just been diagnosed with type 2 diabetes and prescribed insulin. The nurse should instruct the patient to report any signs and symptoms of hypoglycemia that might result from an overdose of insulin, which include which of the following? Select all that apply.
1.	Polyphagia	
2.	Polyuria	
3.	Confusion	
4.	Diaphoresis	
5.	Polydipsia	

____	95.	A patient’s laboratory test results indicate a decreased glycated hemoglobin level. The nurse is aware that this finding is consistent with which of the following conditions? Select all that apply.
1.	Chronic blood loss	
2.	Chronic renal failure	
3.	Diabetes	
4.	Hemolytic anemia	
5.	Splenectomy	

____	96.	A nurse is performing venipuncture on a patient to obtain a specimen for human chorionic gonadotropin (HCG). The nurse understands that this test is used for which of the following purposes? Select all that apply.
1.	Assess kidney function	
2.	Assist in verification of pregnancy	
3.	Screen for neural tube defects	
4.	Evaluate certain tumors	
5.	Indicate a nonspecific inflammatory response	

____	97.	A nurse is providing counseling to a woman who is contemplating having an abortion after learning that the fetus has a chromosomal abnormality. The father of the unborn child is present. Which of the following actions should the nurse take? Select all that apply.
1.	Ask the father to leave.	
2.	Provide a nonjudgmental atmosphere.	
3.	Discuss the difficulties of delivering and raising a developmentally challenged infant.	
4.	Explore the options of abortion and adoption.	
5.	Discuss feelings the mother and father may have.	

____	98.	A nurse is providing counseling to a patient who is taking cyclosporine and preparing to perform blood testing to determine blood level of this drug. Which of the following should the nurse teach the patient? Select all that apply.
1.	Take NSAIDs for pain before the procedure.	
2.	Discontinue the medication for 6 weeks following organ transplantation.	
3.	Avoid alcohol while on this medication.	
4.	Provide instructions regarding drug interactions.	
5.	Take the medication 30 minutes before eating.	

____	99.	A nurse is observing a patient following testing of cyclosporine levels. Increased severity of which of the following are signs and symptoms of cyclosporine toxicity, which the nurse should be looking for in this patient? Select all that apply.
1.	Nausea	
2.	Hypotension	
3.	Stomatitis	
4.	Fever	
5.	Seizures	

____	100.	A patient’s laboratory test results indicate decreased serum magnesium. Based on knowledge of the role of magnesium in the body, the nurse should expect which of the following processes to be affected by this deficiency? Select all that apply.
1.	Digestion of fats	
2.	Transport of oxygen	
3.	Protein synthesis	
4.	Muscle contraction	
5.	Transmission of nerve impulses	

____	101.	The patient’s laboratory test results indicate an increased serum magnesium level. The nurse should assess this patient for further signs of which of the following conditions? Select all that apply.
1.	Addison’s disease	
2.	Alcoholism	
3.	Dehydration	
4.	Pregnancy	
5.	Hypothyroidism	

____	102.	A nurse is providing nutritional teaching to a patient with a magnesium deficiency. Which of the following foods are good sources of magnesium and should therefore be recommended by the nurse for this patient? Select all that apply.
1.	Spinach	
2.	Sunflower seeds	
3.	Oranges	
4.	Shrimp	
5.	Chicken	

____	103.	A nurse is reviewing the results of a patient’s newborn screening. Based on the results the nurse anticipates confirmatory testing. Which of the following are examples of confirmatory tests, as opposed to core tests? Select all that apply.
1.	Early hearing loss detection and intervention	
2.	DNA testing	
3.	Fatty acid oxidation probe tests	
4.	Enzyme assays of blood samples	
5.	Phenylketonuria	

____	104.	A nurse is collecting a blood specimen from a neonate for neonatal blood screening. Which of the following actions should the nurse take? Select all that apply.
1.	Collect the specimen within 12 hours of birth.	
2.	Apply the specimen to circles on filter paper.	
3.	Allow the filter paper sample to dry.	
4.	Collect the specimen immediately following blood transfusion.	
5.	Lightly touch the specimen after 5 minutes to ensure dryness.	

____	105.	A nurse is working with a patient whose test results indicate a serum potassium level of 2.2 mEq/L. Which of the following associated symptoms should the nurse expect to find in this patient? Select all that apply.
1.	Thirst	
2.	Oliguria	
3.	Hypotension	
4.	Depressed T waves	
5.	Diarrhea	

____	106.	A patient’s laboratory test results indicate a serum potassium level of 6.3 mEq/L. Which of the following conditions should the nurse expect in this patient? Select all that apply.
1.	Acute renal failure	
2.	Ketoacidosis	
3.	Near drowning	
4.	Congestive heart failure	
5.	Anorexia nervosa	

____	107.	A patient’s laboratory test results indicate increased prealbumin levels. The nurse should assess this patient for signs of which of the following conditions? Select all that apply.
1.	Liver disease	
2.	Alcoholism	
3.	Chronic renal failure	
4.	Malnutrition	
5.	Corticosteroid use	

____	108.	The nurse is reviewing a patient’s laboratory test results, which indicate an increased total protein level. The nurse should recognize that this finding is associated with which of the following conditions? Select all that apply.
1.	Dehydration	
2.	Burns	
3.	Myeloma	
4.	Cirrhosis	
5.	Leprosy	

____	109.	A male patient is found to have a decreased total testosterone level. Which of the following conditions should the nurse assess for in this client? Select all that apply.
1.	Smoking	
2.	Alcoholism	
3.	Sedentary lifestyle	
4.	Depression	
5.	Malnutrition	

____	110.	A nurse is preparing to collect blood for a free thyroxine (FT4) test. The nurse is aware that which of the following are advantages of this test? Select all that apply.
1.	Free T4 levels are not affected by fluctuations in thyroxine-binding globulin (TBG) levels.	
2.	It is the most accurate indicator of T4.	
3.	It is the first-line test in evaluating thyroid hormone levels.	
4.	It is useful in evaluating thyroid disease when thyroid-stimulating hormone (TSH) levels provide insufficient information.	
5.	It is recommended during treatment for hyperthyroidism until symptoms have abated.	

____	111.	A patient’s laboratory test results indicate an increased triglycerides (TGs) level. Which of the following associated conditions should the nurse screen the patient for? Select all that apply.
1.	Alcoholism	
2.	Hypertension	
3.	End-stage liver disease	
4.	Obesity	
5.	Hyperthyroidism	

____	112.	A nurse is providing pre-test instructions to a patient who will be undergoing blood testing for triglycerides at his next appointment in about a month. Which of the following directions should the nurse give the patient? Select all that apply.
1.	Avoid exercise for 4 hours before the test.	
2.	Discontinue hypertension medications 1 week before the test.	
3.	Maintain a stable diet for 3 weeks before the test.	
4.	Avoid alcohol consumption for 3 days before the test.	
5.	Fast for 2 hours before specimen collection.	

____	113.	A patient’s laboratory test results indicate an increased blood urea nitrogen (BUN) level. Which of the following conditions should the nurse most suspect in this patient? Select all that apply.
1.	Inadequate dietary protein	
2.	Acute renal failure	
3.	Congestive heart failure	
4.	Pregnancy	
5.	Muscle wasting from starvation	

____	114.	A nurse is reviewing a patient’s recent laboratory test results and notes that the blood urea nitrogen (BUN) level is 105 mg/dL. What interventions should the nurse anticipate for this patient? Select all that apply.
1.	Administration of intravenous bicarbonate	
2.	Continuation of nephrotoxic medication regimens	
3.	A low-protein diet	
4.	Pelvic computed tomography (CT) scan with contrast medium	
5.	Hemodialysis	

____	115.	A patient’s laboratory test results indicate a decreased vitamin D level. The nurse should assess this client for which of the following associated conditions? Select all that apply.
1.	Celiac disease	
2.	Osteomalacia	
3.	Scurvy	
4.	Rickets	
5.	Cardiac dysrhythmias	

____	116.	A nurse is providing teaching to a patient who has vitamin D deficiency. Which of the following should the nurse recommend? Select all that apply.
1.	Citrus fruits	
2.	Fortified dairy products	
3.	Cod liver oil	
4.	Dark green, leafy vegetables	
5.	Lean beef	

Other

	117.	Below are the components of the nursing process. Put them in the correct order.
_____ 1. Diagnosis
_____ 2. Evaluation
_____ 3. Implementation
_____ 4. Planning
_____ 5. Assessment

	118.	Below are the steps for performing an air conduction hearing test on an infant as part of a newborn screening. Put them in the correct order.
_____ 1. Apply electrodes to the scalp and place earphones in the ears.
_____ 2. Repeat the process until the same response is achieved at a 50% response rate at the same hertz level.
_____ 3. Increase the intensity 5 dB at a time until the tone is heard.
_____ 4. Deliver a tone at 1,000 Hz.
_____ 5. Perform an otoscopy examination to ensure external ear canal is free from obstruction.
_____ 6. Decrease the intensity 10 dB at a time until there is no response.

	119.	Below are the steps for collecting a blood specimen for a filter paper test on a neonate. Put them in the correct order.
_____ 1. Perform a heel stick.
_____ 2. Use gauze to dry the stick area completely.
_____ 3. Cleanse the infant’s heel with an antiseptic.
_____ 4. Allow the card to air dry for several hours.
_____ 5. Touch the filter paper to the puncture site.
_____ 6. Gently squeeze the infant’s heel.

Chapter 1
Answer Section

MULTIPLE CHOICE

	1.	ANS:	2
Rationale: The two organs that play a crucial role in the distribution and storage of glucose are the liver and pancreas. The kidneys, stomach, and spleen play no significant role in glucose levels in the blood.

Page: 3
Heading: Carbohydrates 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	2.	ANS:	1
Rationale: Creatinine is nonprotein nitrogenous waste generated by the chemical production of energy from phosphocreatine in skeletal muscles and some organs (notably the heart and brain). Urea and creatinine are transported to the kidneys and excreted in the urine. As such, both substances are important indicators of renal function.

Page: 5
Heading: Cellular Waste Products 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

PTS:	1	CON:	Urinary Elimination	

	3.	ANS:	2
Rationale: Hormones stimulate hunger pangs and regulate metabolism, stimulate or inhibit growth, influence emotions, prepare the body for survival responses such as fight or flight, prepare the body for major changes (e.g., puberty, reproduction, and menopause), and provide anti-inflammatory and immunizing effects.

Page: 6
Heading: Hormones 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	4.	ANS:	2
Rationale: Explain that specimen collection by venipuncture takes approximately 5 to 10 minutes.

Page: 9
Heading: Universal Pretest Pearls (Planning) 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Application [Applying] 
Concept: Hematologic Regulation 
Difficulty: Easy

PTS:	1	CON:	Hematologic Regulation

	5.	ANS:	4
Rationale: Bleeding or bruising can be prevented, once the needle has been removed, by applying direct pressure to the venipuncture site with dry gauze for a minute or two. Administering an anticoagulant is unnecessary and would not prevent bleeding or bruising. Applying an antibiotic ointment to the site and having the patient lie down would also not prevent bleeding or bruising. 

Page: 9
Heading: Universal Pretest Pearls (Planning) 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Clotting 
Difficulty: Easy

PTS:	1	CON:	Clotting

	6.	ANS:	2
Rationale: Alanine aminotransferase is used to assess liver function related to liver disease and/or damage. The other tests listed are not used for this purpose.

Page: 10
Heading: Alanine Aminotransferase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	7.	ANS:	2
Rationale: Blood albumin level is increased in any condition that results in a decrease of plasma water (e.g., dehydration). It is decreased in acute and chronic liver disease (e.g., alcoholism, cirrhosis, and hepatitis) and in inflammation and chronic diseases that result in production of acute-phase reactant and other globulin proteins, such as bacterial infections, and in conditions that result in increased loss over body surface area, such as burns.

Page: 13
Heading: Albumin and Albumin/Globulin Ratio 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

PTS:	1	CON:	Fluid and Electrolyte Balance

	8.	ANS:	1
Rationale: Albumin levels are affected by posture. Results from specimens collected in an upright posture are higher than results from specimens collected in a supine position. Exercise just before collection, carbohydrate intake, and anxiety are not associated with a falsely elevated result.

Page: 13
Heading: Albumin and Albumin/Globulin Ratio 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Application [Applying] 
Concept: Digestion 
Difficulty: Moderate

PTS:	1	CON:	Digestion

	9.	ANS:	3
Rationale: Hematomas occur more often in elderly or frail patients or those with veins that are difficult to access. Some other more unusual complications of venipuncture include cellulitis, phlebitis, inadvertent arterial puncture, and sepsis. Sepsis can be caused by introduction of bacteria from the surface of the skin into the blood as the result of improper cleansing of the venipuncture site. Immunocompromised patients are at higher risk for developing this complication.

Page: 15
Heading: Alkaline Phosphatase and Isoenzymes 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Skin Integrity| Difficulty: Moderate

PTS:	1	CON:	Skin Integrity		

	10.	ANS:	2
Rationale: Amylase is a digestive enzyme mainly secreted by the acinar cells of the pancreas and by the parotid glands. Pancreatic amylase is secreted into the pancreatic common bile ducts and then into the duodenum, where it assists in the digestion of carbohydrates by splitting starch into disaccharides. Amylase is a sensitive indicator of pancreatic acinar cell damage and pancreatic obstruction.

Page: 18
Heading: Amylase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Digestion 
Difficulty: Moderate

PTS:	1	CON:	Digestion

	11.	ANS:	4
Rationale: Usually after acute symptoms subside and bowel sounds return, patients are given a clear liquid diet, progressing to a low-fat, high-carbohydrate diet.

Page: 20
Heading: Amylase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	12.	ANS:	1
Rationale: Creatinine levels should be monitored every 2 to 3 days to detect renal impairment due to toxic drug levels.

Page: 22
Heading: Antimicrobial Drugs—Aminoglycosides: Amikacin, Gentamicin, Tobramycin; Tricyclic Glycopeptide: Vancomycin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

PTS:	1	CON:	Urinary Elimination	

	13.	ANS:	2
Rationale: The nurse should obtain a culture before and after the first dose of aminoglycosides to detect any signs of nephrotoxicity. Blood drawn in serum separator tubes (gel tubes) will be rejected for analysis, so the nurse should not use these. Drugs that may decrease aminoglycoside efficacy include penicillins (e.g., carbenicillin, piperacillin). The nurse should not administer a penicillin to this patient. The nurse should remind the patient of the importance of completing the entire course of antibiotic therapy, even if signs and symptoms disappear before the completion of therapy.

Page: 22
Heading: Antimicrobial Drugs—Aminoglycosides: Amikacin, Gentamicin, Tobramycin; Tricyclic Glycopeptide: Vancomycin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

PTS:	1	CON:	Urinary Elimination	

	14.	ANS:	4
Rationale: Signs and symptoms of toxic levels of these antibiotics are similar and include loss of hearing and decreased renal function. Toxic levels are not associated with loss of consciousness, sensation, or sight.

Page: 23
Heading: Antimicrobial Drugs—Aminoglycosides: Amikacin, Gentamicin, Tobramycin; Tricyclic Glycopeptide: Vancomycin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Sensory Perception 
Difficulty: Moderate

PTS:	1	CON:	Sensory Perception	

	15.	ANS:	2
Rationale: Women of childbearing age who are taking carbamazepine, phenobarbital, phenytoin, primidone, and/or valproic acid should also be prescribed supplemental folic acid to reduce the incidence of neural tube defects. Ascorbic acid (vitamin C), riboflavin (vitamin B2), and niacin (vitamin B3) do not help protect against neural tube defects.

Page: 27
Heading: Anticonvulsant Drugs: Carbamazepine, Ethosuximide, Lamotrigine, Phenobarbital, Phenytoin, Primidone, Valproic Acid 
Integrated Processes: Teaching and Learning 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Female Reproduction 
Difficulty: Moderate

PTS:	1	CON:	Female Reproduction	

	16.	ANS:	1
Rationale: The metabolism of many commonly prescribed medications is driven by the cytochrome P450 family of enzymes. Genetic variants can alter enzymatic activity, which results in a spectrum of effects ranging from the total absence of drug metabolism to ultrafast metabolism. Impaired drug metabolism can prevent the intended therapeutic effect or even lead to serious adverse drug reactions. Poor metabolizers are at increased risk for drug-induced side effects due to accumulation of drug in the blood, whereas ultra-rapid metabolizers require a higher-than-normal dosage because the drug is metabolized over a shorter duration than intended. Poor metabolizers are not at greater risk of having an anaphylactic response to the medication or of becoming dependent on the medication.

Page: 29
Heading: Antidepressant Drugs (Cyclic): Amitriptyline, Nortriptyline, Protriptyline, Doxepin, Imipramine 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	17.	ANS:	2
Rationale: An amitriptyline level of greater than 500 ng/mL represents that a critical finding be communicated immediately to the requesting health-care provider.

Page: 30
Heading: Antidepressant Drugs (Cyclic): Amitriptyline, Nortriptyline, Protriptyline, Doxepin, Imipramine 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	18.	ANS:	2
Rationale: AST level is moderately increased (three to five times normal levels) in cirrhosis. It is significantly increased (greater than five times normal levels) in acute pancreatitis. It is slightly increased (two to three times normal levels) in cerebrovascular accident and hemolytic anemia.

Page: 31
Heading: Aspartate Aminotransferase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	19.	ANS:	1
Rationale: AST level is significantly increased (greater than five times normal levels) in acute pancreatitis. It is moderately increased (three to five times normal levels) in cirrhosis. It is slightly increased (two to three times normal levels) in cerebrovascular accident and hemolytic anemia.

Page: 31
Heading: Aspartate Aminotransferase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	20.	ANS:	4
Rationale: AST level is decreased in hemodialysis, presumed to be related to a corresponding deficiency of vitamin B6 observed in hemodialysis patients. 

Page: 32
Heading: Aspartate Aminotransferase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	21.	ANS:	4
Rationale: When bilirubin concentration increases, the yellowish pigment deposits in skin and sclera. This increase in yellow pigmentation is termed jaundice or icterus. Elevated bilirubin level is not associated with pallor (paleness of the skin associated with poor perfusion), cyanosis (bluish coloration of the skin caused by a lack of oxygen in the blood), or hyperemia (a reddish coloration of the skin caused by increased blood flow to the area).

Page: 34
Heading: Bilirubin and Bilirubin Fractions 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Hematologic Regulation 
Difficulty: Moderate

PTS:	1	CON:	Hematologic Regulation

	22.	ANS:	1
Rationale: The most common cause of hypocalcemia (low calcium levels) is hypoalbuminemia. The most common causes of hypercalcemia are hyperparathyroidism and cancer (with or without bone metastases). Acromegaly is a cause of increased calcium level, related to alteration in vitamin D metabolism, resulting in increased calcium.

Page: 39
Heading: Calcium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	23.	ANS:	2
Rationale: Calcium exhibits diurnal variation; serial samples should be collected at the same time of day for comparison. Posture, anxiety, and recent exercise are not known to affect blood calcium level.

Page: 40
Heading: Calcium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	24.	ANS:	3
Rationale: Serum or plasma carbon dioxide (CO2) measurement is usually done as part of an electrolyte panel. Total CO2 is an important component of the body’s buffering capability, and measurements are used mainly in the evaluation of acid-base balance. It is not used to evaluate blood glucose, lipids, or pathogenic organisms.

Page: 43
Heading: Carbon Dioxide 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: pH Regulation 
Difficulty: Moderate

PTS:	1	CON:	pH Regulation		

	25.	ANS:	1
Rationale: Chloride levels generally increase and decrease in direct proportion to sodium levels and inverse proportion to bicarbonate levels.

Page: 45
Heading: Chloride, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: pH Regulation 
Difficulty: Moderate

PTS:	1	CON:	pH Regulation		

	26.	ANS:	3
Rationale: The nurse should ensure that the patient has complied with dietary and medication restrictions as well as other pretesting preparations, including that food has been restricted for at least 12 hours prior to the procedure.

Page: 50
Heading: Cholesterol, HDL and LDL 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	27.	ANS:	2
Rationale: New guidelines from the ACC and AHA indicate a movement away from the use of LDL cholesterol targets in determining treatment with statins. The recommendations focus on selecting (1) the patients who fall into four groups most likely to benefit from statin therapy, and (2) the level of statin intensity most likely to affect or reduce development of atherosclerotic cardiovascular disease (not a standard dosage). Recommendations regarding lifestyle include adherence to a Mediterranean-style or DASH (Dietary Approaches to Stop Hypertension)-style diet, not a low-cholesterol diet.

Page: 52
Heading: Cholesterol, HDL and LDL 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	28.	ANS:	3
Rationale: According to the National Cholesterol Education Program, maintaining cholesterol levels less than 200 mg/dL significantly reduces the risk of coronary heart disease.

Page: 52
Heading: Cholesterol, Total 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Easy

PTS:	1	CON:	Perfusion

	29.	ANS:	3
Rationale: CRP is a glycoprotein produced by the liver in response to acute inflammation. CRP disappears from the serum rapidly when inflammation has subsided. The inflammatory process and its association with atherosclerosis make the presence of CRP, as detected by highly sensitive CRP assays, a potential marker for coronary artery disease. It is believed that the inflammatory process may instigate the conversion of a stable plaque to a weaker one that can rupture and occlude an artery. CRP is not used to assess for type 2 diabetes, Alzheimer’s disease, or lung cancer.

Page: 55
Heading: C-Reactive Protein 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	30.	ANS:	2
Rationale: NSAIDs, salicylates, and steroids may cause false-negative results because of suppression of inflammation. Chemotherapy or the presence of an intrauterine device may cause a falsely elevated level, not a false-negative result. Smoking would not affect CRP level. 

Page: 56
Heading: C-Reactive Protein 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Application [Applying] 
Concept: Inflammation 
Difficulty: Moderate

PTS:	1	CON:	Inflammation		

	31.	ANS:	2
Rationale: Acute MI releases CK into the serum within the first 48 hours; values return to normal in about 3 days. The isoenzyme CK-MB appears in the first 4 to 6 hours, peaks in 24 hours, and usually returns to normal in 72 hours.

Page: 57
Heading: Creatine Kinase and Isoenzymes 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	32.	ANS:	1
Rationale: Three isoenzymes, based on primary location, have been identified by electrophoresis: brain and lungs (CK-BB), cardiac (CK-MB), and skeletal muscle (CK-MM). A brain infarction would be indicated by an elevated CK-BB level. Congestive heart failure would be indicated by an elevated CK-MB level. Muscular dystrophy and gastrointestinal tract infarction would be indicated by an elevated CK-MM level.

Page: 57
Heading: Creatine Kinase and Isoenzymes 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	33.	ANS:	2
Rationale: A sedentary lifestyle would be indicated by a decreased CK level related to decreased muscle mass. Three isoenzymes, based on primary location, have been identified by electrophoresis: brain and lungs (CK-BB), cardiac (CK-MB), and skeletal muscle (CK-MM). A brain infarction would be indicated by an elevated CK-BB level. Muscular dystrophy and gastrointestinal tract infarction would be indicated by an elevated CK-MM level.

Page: 58
Heading: Creatine Kinase and Isoenzymes 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	34.	ANS:	2
Rationale: The creatinine clearance test measures a blood sample and a urine sample to determine the rate at which the kidneys are clearing creatinine from the blood; this reflects the glomerular filtration rate (GFR). It is not used to measure coagulation rate, metabolism rate, or gastric emptying rate.

Page: 60
Heading: Creatinine, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

PTS:	1	CON:	Urinary Elimination	

	35.	ANS:	2
Rationale: Fasting blood glucose readings greater than 126 mg/dL on subsequent days after a minimum of an 8-hour fast is indicative of diabetes.

Page: 63
Heading: Glucose 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	36.	ANS:	4
Rationale: Glycated hemoglobin is used to monitor treatment in individuals with diabetes by evaluating their long-term glycemic control. Glucose is used to assist in the diagnosis of diabetes and to evaluate disorders of carbohydrate metabolism such as malabsorption syndrome, but it only provides a snapshot of blood glucose level at one point in time, whereas glycated hemoglobin reveals glucose level over several months. Creatinine is used to assess kidney function found in acute and chronic renal failure, related to drug reaction and disease such as diabetes. The presence of C-reactive protein indicates a nonspecific inflammatory response; therefore, this highly sensitive test is used to assess risk for cardiovascular and peripheral artery disease.

Page: 63
Heading: Glycated Hemoglobin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	37.	ANS:	3
Rationale: The nurse should inform the patient that this study can assist in evaluating blood sugar control over approximately the past 3 months.

Page: 69
Heading: Glycated Hemoglobin 
Integrated Processes: Teaching and Learning 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Easy

PTS:	1	CON:	Metabolism

	38.	ANS:	4
Rationale: A decreased HCG level can indicate an ectopic pregnancy. Presence of an HCG-secreting tumor, multiple gestation pregnancy, and a healthy pregnancy are all associated with increased HCG levels, not decreased.

Page: 71
Heading: Human Chorionic Gonadotropin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Pregnancy 
Difficulty: Moderate

PTS:	1	CON:	Pregnancy

	39.	ANS:	3
Rationale: Immunosuppressants, including methotrexate, are metabolized and excreted by the liver and kidneys and are therefore contraindicated in patients with hepatic and renal disease. Methotrexate is used to treat rheumatoid arthritis and thus is not contraindicated for this condition. It is also not contraindicated for heart disease or breast cancer.

Page: 74
Heading: Immunosuppressants: Cyclosporine, Methotrexate, Everolimus, Sirolimus, and Tacrolimus 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Safety 
Difficulty: Moderate

PTS:	1	CON:	Safety

	40.	ANS:	3
Rationale: Lipase is released into the bloodstream when damage occurs to the pancreatic acinar cells. Its presence in the blood indicates pancreatic disease because the pancreas is the only organ that secretes this enzyme.

Page: 76
Heading: Lipase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Digestion 
Difficulty: Easy

PTS:	1	CON:	Digestion

	41.	ANS:	2
Rationale: Serum lipase levels increase with hemodialysis; therefore, predialysis specimens should be collected for lipase analysis. Exercise, smoking, and magnetic resonance imaging do not increase blood lipase levels.

Page: 77
Heading: Lipase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Hematologic Regulation 
Difficulty: Moderate

PTS:	1	CON:	Hematologic Regulation

	42.	ANS:	1
Rationale: The nurse should administer vitamin B12, as ordered, to the patient with decreased lipase levels, especially if his or her disease prevents adequate absorption of the vitamin.

Page: 77
Heading: Lipase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	43.	ANS:	3
Rationale: Increased serum myoglobin levels are associated with conditions that cause skeletal or cardiac muscle damage, as damaged muscle cells release myoglobin into the circulation. A heart attack, or myocardial infarction, results in damage to the cardiac muscle, and therefore release of myoglobin. Myasthenia gravis and rheumatoid arthritis are associated with a decreased myoglobin level. Pancreatitis is not associated with myoglobin level.

Page: 80
Heading: Myoglobin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	44.	ANS:	2
Rationale: An increased serum myoglobin level is associated with cocaine use, as rhabdomyolysis is a complication of cocaine use or overdose, and rhabdomyolysis is a condition characterized by the breakdown of skeletal muscle. Increased myoglobin level is not associated with abuse of marijuana, alcohol, or methamphetamine.

Page: 80
Heading: Myoglobin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Addiction 
Difficulty: Moderate

PTS:	1	CON:	Addiction

	45.	ANS:	1
Rationale: The goal of EHDI is to assure that permanent hearing loss is identified before 3 months of age, appropriate and timely intervention services are provided before 6 months of age, families of infants with hearing loss receive culturally competent support, and tracking and data management systems for newborn hearing screens are linked with other relevant public health information systems.

Page: 82
Heading: Newborn Screening 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Sensory Perception 
Difficulty: Moderate

PTS:	1	CON:	Sensory Perception	

	46.	ANS:	3
Rationale: Cystic fibrosis (CF) is a genetic disease that affects normal functioning of the exocrine glands, causing them to excrete large amounts of electrolytes. CF is characterized by abnormal exocrine secretions within the lungs, pancreas, small intestine, bile ducts, and skin. Some of the signs and symptoms that may be demonstrated by the newborn with CF include failure to thrive, salty sweat, chronic respiratory problems (constant coughing or wheezing, thick mucus, recurrent lung and sinus infections, and nasal polyps), and chronic gastrointestinal problems (diarrhea, constipation, pain, gas, and greasy, malodorous stools that are bulky and pale colored). Patients with CF have sweat electrolyte levels two to five times normal levels. The sweat electrolyte test is still considered the gold standard diagnostic for CF. None of the other tests listed is indicated for CF.

Page: 83
Heading: Newborn Screening 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Pregnancy 
Difficulty: Difficult

PTS:	1	CON:	Pregnancy

	47.	ANS:	4
Rationale: PTH is secreted by the parathyroid glands in response to decreased levels of circulating calcium, not to decreased levels of sodium, magnesium, or potassium.

Page: 96
Heading: Parathyroid Hormone 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

PTS:	1	CON:	Fluid and Electrolyte Balance

	48.	ANS:	2
Rationale: A decreased PTH level is associated with sarcoidosis, related to increased calcium levels that result from this condition. An increased PTH level is associated with pseudogout (calcium is lost due to deposits in the joint; decrease in calcium stimulates PTH production), primary hyperparathyroidism (which results in excess PTH production), and Zollinger-Ellison syndrome (related to poor intestinal absorption of calcium and vitamin D; decreased calcium stimulates PTH production).

Page: 98
Heading: Parathyroid Hormone 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

PTS:	1	CON:	Fluid and Electrolyte Balance

	49.	ANS:	2
Rationale: The sample should be placed in an ice slurry immediately after collection. Information on the specimen label should be protected from water in the ice slurry by first placing the specimen in a protective plastic bag.

Page: 98
Heading: Parathyroid Hormone 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

PTS:	1	CON:	Fluid and Electrolyte Balance

	50.	ANS:	1
Rationale: False increases are seen when unprocessed samples are left at room temperature because a significant amount of potassium leaks out of the cells within a few hours. Plasma or serum should be separated from cells within 4 hours of collection. Drugs that can cause a decrease in potassium levels include acetylsalicylic acid (aspirin). Neither smoking nor the specimen being exposed to sunlight would affect the serum potassium level.

Page: 101
Heading: Potassium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

PTS:	1	CON:	Fluid and Electrolyte Balance

	51.	ANS:	1
Rationale: Prealbumin is important in the metabolism of retinol-binding protein, which is needed for transporting vitamin A (retinol). Thus, a deficiency in prealbumin would lead to a deficiency in vitamin A. Prealbumin is not associated with transport of the other vitamins.

Page: 103
Heading: Prealbumin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	52.	ANS:	4
Rationale: The nurse should ensure that the patient has complied with dietary restrictions and that food has been restricted for at least 8 hours prior to the procedure. Reference ranges are often based on fasting populations to provide some level of standardization for comparison. The presence of lipids in the blood may also interfere with the test method; fasting eliminates this potential source of error, especially if the patient has elevated lipid levels.

Page: 104
Heading: Prealbumin 
Integrated Processes: Teaching and Learning 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	53.	ANS:	4
Rationale: Albumin, the protein present in the highest concentrations, is the main transport protein in the body. Globulin includes haptoglobin, ceruloplasmin, and a2-macroglobulin.

Page: 105
Heading: Protein, Blood, Total and Fractions 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	54.	ANS:	2
Rationale: A patient being recumbent during venipuncture can cause the total protein to be significantly lower than normal. Hemolysis, the tourniquet being left on the arm for more than 60 seconds, and the patient being on anabolic steroids, are all factors that would falsely elevate, not decrease, the total protein level.

Page: 106
Heading: Protein, Blood, Total and Fractions 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Analysis [Analyzing] 
Concept: Nutrition 
Difficulty: Difficult

PTS:	1	CON:	Nutrition

	55.	ANS:	3
Rationale: Sodium testing is used to assess electrolyte balance related to hydration levels and disorders such as diarrhea and vomiting and to monitor the effect of diuretic use. Magnesium testing is used to assess electrolyte balance related to magnesium levels to assist in diagnosis, monitoring diseases, and therapeutic interventions such as hemodialysis. Calcium testing is used to investigate various conditions related to abnormally increased or decreased calcium levels. Potassium testing is used to evaluate fluid and electrolyte balance related to potassium levels toward diagnosing disorders such as acidosis, renal failure, and dehydration, and to monitor the effectiveness of therapeutic interventions.

Page: 107
Heading: Sodium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

PTS:	1	CON:	Fluid and Electrolyte Balance

	56.	ANS:	1
Rationale: Sodium level is increased in diabetes due to dehydration related to frequent urination, which is one of the symptoms of this disease. A person with diabetes is not more likely to have a high-sodium diet. An increased blood glucose level is not associated with excessive production of aldosterone, and diabetes is not associated with excessive sweating.

Page: 108
Heading: Sodium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Difficult

PTS:	1	CON:	Fluid and Electrolyte Balance

	57.	ANS:	4
Rationale: Administration of saline for replacement requires close attention to serum and urine osmolality. Blood glucose level, heart rate and rhythm, and respiratory rate are not as important to monitor in this situation as is serum and urine osmolality.

Page: 109
Heading: Sodium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

PTS:	1	CON:	Fluid and Electrolyte Balance

	58.	ANS:	2
Rationale: In males, a testicular, adrenal, or pituitary tumor can cause an overabundance of testosterone, triggering precocious puberty. A decreased testosterone level is associated with Klinefelter’s syndrome (chromosome abnormality XXY associated with testicular failure), cryptorchidism (related to dysfunctional testes), and primary hypopituitarism.

Page: 111
Heading: Testosterone, Total 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Male Reproduction 
Difficulty: Moderate

PTS:	1	CON:	Male Reproduction	

	59.	ANS:	3
Rationale: In females, the ovaries and adrenal glands secrete small amounts of testosterone. Therefore, anovulation—or cessation of ovulation—can be a cause of decreased testosterone level in females. Increased testosterone level is associated with ovarian tumor, adrenal hyperplasia, and hyperthyroidism. 

Page: 111
Heading: Testosterone, Total 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Female Reproduction 
Difficulty: Moderate

PTS:	1	CON:	Female Reproduction	

	60.	ANS:	3
Rationale: Elevated TSH levels combined with decreased T4 levels indicate hypothyroidism and thyroid gland dysfunction. In general, decreased TSH and T4 levels indicate secondary congenital hypothyroidism and pituitary hypothalamic dysfunction. A normal TSH level and a depressed T4 level may indicate (1) hypothyroidism owing to a congenital defect in T4-binding globulin, or (2) transient congenital hypothyroidism owing to hypoxia or prematurity.

Page: 113
Heading: Thyroid-Stimulating Hormone 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Metabolism 
Difficulty: Difficult

PTS:	1	CON:	Metabolism

	61.	ANS:	1
Rationale: Graves’ disease is associated with hyperthyroidism, a condition marked by excessive production of thyroid hormone. An increase in thyroid hormone levels activates the Rationale loop to decrease production of TSH. Klinefelter’s syndrome, Down syndrome, and Turner syndrome are not associated with the thyroid gland or TSH levels.

Page: 113
Heading: Thyroid-Stimulating Hormone 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	62.	ANS:	3
Rationale: A decreased free T4 level is associated with late pregnancy.

Page: 116
Heading: Thyroxine, Free 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Pregnancy 
Difficulty: Moderate

PTS:	1	CON:	Pregnancy

	63.	ANS:	4
Rationale: Drugs that may increase free T4 levels include acetylsalicylic acid (aspirin), amiodarone, halofenate, heparin, iopanoic acid, levothyroxine, methimazole, and iodinated radiographic agents. Drugs that may decrease free T4 levels include amiodarone, anabolic steroids, asparaginase, methadone, methimazole, oral contraceptives, and phenylbutazone.

Page: 116
Heading: Thyroxine, Free 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	64.	ANS:	3
Rationale: Triglyceride levels increase with age and are higher in men than in women and in overweight and obese people than in those with normal weight. Levels in African Americans are approximately 10 to 20 mg/dL lower than in whites. There is no correlation between triglyceride levels and diabetes or breast cancer. The 65-year-old white man who is obese has three risk factors (age, race, and weight) and thus is the most at risk for having elevated triglyceride levels.

Page: 117
Heading: Triglycerides 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	65.	ANS:	4
Rationale: Troponins I and T testing is used to assist in evaluating myocardial muscle damage related to disorders such as myocardial infarction. Triglycerides testing is used to evaluate triglyceride levels to assess cardiovascular disease risk and evaluate the effectiveness of therapeutic interventions. Creatinine testing is used to assess kidney function in acute and chronic renal failure, related to drug reaction and disease such as diabetes. Prealbumin testing is used to assess nutritional status and evaluate liver function toward diagnosing disorders such as malnutrition and chronic renal failure.

Page: 120
Heading: Troponins I and T 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

	66.	ANS:	2
Rationale: Cardiac troponin I begins to rise 2 to 6 hours after MI. It has a biphasic peak: it initially peaks at 15 to 24 hours after MI and then exhibits a lower peak after 60 to 80 hours. Cardiac troponin T levels rise 2 to 6 hours after MI and remain elevated. Both proteins return to the reference range 7 days after MI.

Page: 120
Heading: Troponins I and T 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

PTS:	1	CON:	Perfusion

MULTIPLE RESPONSE

	67.	ANS:	1, 3
Page: 4
Heading: Water and Electrolytes 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

	Rationale	
1.	This is correct. Electrolytes are essential for the completion of many biological functions, including helping maintain acid–base balance in the metabolic and respiratory compensatory systems.	
2. 	This is incorrect. Electrolyte imbalance is not significantly associated with elevated blood glucose. 	
3. 	This is correct. Electrolytes are essential for the completion of many biological functions, including controlling the process of osmosis (the movement of water).	
4. 	This is incorrect. Electrolyte imbalance is not significantly associated with elevated blood lipids.	
5. 	This is incorrect. Electrolyte imbalance is not significantly associated with muscle atrophy.	

PTS:	1	CON:	Fluid and Electrolyte Balance

	68.	ANS:	2, 4, 5
Page: 6
Heading: Lipids 
Integrated Processes: Teaching and Learning 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Electrolytes, not cholesterol, help maintain acid–base balance.	
2. 	This is correct. Cholesterol is a very important lipid that plays a crucial role in other specific functions in the body, including serving as a precursor molecule in the formation of vitamin D and sterol hormones such as corticosteroids and sex hormones.	
3. 	This is incorrect. Enzymes, not cholesterol, catalyze biochemical processes.	
4. 	This is correct. Cholesterol serves as a component in bile salts that aid in the emulsification and digestion of fats.	
5. 	This is correct. Cholesterol serves as a component in the myelin sheath to protect nerves and enhance the conduction of nerve impulses.	

PTS:	1	CON:	Nutrition

	69.	ANS:	1, 4, 5
Page: 7
Heading: Vitamins and Minerals 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is correct. The fat-soluble vitamins include A, D, E, and K.	
2. 	This is incorrect. The water-soluble group includes vitamin C and the B vitamins: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin, folic acid (B9), and cobalamin (B12).	
3. 	This is incorrect. The water-soluble group includes vitamin C and the B vitamins: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin, folic acid (B9), and cobalamin (B12).	
4. 	This is correct. The fat-soluble vitamins include A, D, E, and K.	
5. 	This is correct. The fat-soluble vitamins include A, D, E, and K.	

PTS:	1	CON:	Nutrition

	70.	ANS:	1, 2, 4
Page: 9
Heading: Universal Intratest Pearls (Implementation) 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Application [Applying]
Difficulty: Easy

	Rationale	
1.	This is correct. Correct patient identification is crucial prior to any procedure. Positively identify the patient using two unique identifiers such as patient name, date of birth, Social Security number, or medical record number.	
2. 	This is correct. Correct patient identification is crucial prior to any procedure. Positively identify the patient using two unique identifiers such as patient name, date of birth, Social Security number, or medical record number.	
3. 	This is incorrect. Home address is not an acceptable identifier of a patient.	
4. 	This is correct. Correct patient identification is crucial prior to any procedure. Positively identify the patient using two unique identifiers such as patient name, date of birth, Social Security number, or medical record number.	
5. 	This is incorrect. Phone number is not an acceptable identifier of a patient.	

PTS:	1	CON:	Safety

	71.	ANS:	1, 2, 3, 5
Page: 11
Heading: Alanine Aminotransferase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

	Rationale	
1.	This is correct. Alanine aminotransferase is elevated in chronic alcohol abuse, hepatitis, infectious mononucleosis, and myocardial infarction.	
2. 	This is correct. Alanine aminotransferase is elevated in chronic alcohol abuse, hepatitis, infectious mononucleosis, and myocardial infarction.	
3. 	This is correct. Alanine aminotransferase is elevated in chronic alcohol abuse, hepatitis, infectious mononucleosis, and myocardial infarction.	
4. 	This is incorrect. Alanine aminotransferase is decreased in pyridoxal phosphate deficiency.	
5. 	This is correct. Alanine aminotransferase is elevated in chronic alcohol abuse, hepatitis, infectious mononucleosis, and myocardial infarction.	

PTS:	1	CON:	Metabolism

	72.	ANS:	2, 3
Page: 12
Heading: Alanine Aminotransferase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Hematologic Regulation 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Low, not high, blood pressure is indicative of a vasovagal reaction.	
2. 	This is correct. Some patients experience a vasovagal reaction during the venipuncture procedure, evidenced by sweating, low blood pressure, fainting, or near fainting.	
3. 	This is correct. Some patients experience a vasovagal reaction during the venipuncture procedure, evidenced by sweating, low blood pressure, fainting, or near fainting.	
4. 	This is incorrect. Seizure is not associated with a vasovagal reaction.	
5. 	This is incorrect. Rash is not associated with a vasovagal reaction.	

PTS:	1	CON:	Hematologic Regulation

	73.	ANS:	1, 3
Page: 15
Heading: Albumin and Albumin/Globulin Ratio 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is correct. An expected outcome associated with albumin and albumin/globulin ratio is agreeing to abstain from drinking alcohol.	
2. 	This is incorrect. An expected outcome associated with albumin and albumin/globulin ratio is decreasing, not increasing, extravascular fluid volume.	
3. 	This is correct. An expected outcome associated with albumin and albumin/globulin ratio is making nutritional selections that support the maintenance of a healthy body weight.	
4. 	This is incorrect. Reducing carbohydrate intake is not an expected outcome associated with albumin and albumin/globulin ratio.	
5. 	This is incorrect. Engaging in regular exercise is not an expected outcome associated with albumin and albumin/globulin ratio.	

PTS:	1	CON:	Nutrition

	74.	ANS:	1, 2, 4
Page: 17
Heading: Alkaline Phosphatase and Isoenzymes 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Digestion 
Difficulty: Moderate

	Rationale	
1.	This is correct. Elevated ALP level is associated with the release of alkaline phosphatase from damaged bone, biliary tract, and liver cells. Conditions associated with this finding include viral hepatitis, healing fractures, and osteogenic sarcoma.	
2. 	This is correct. Conditions associated with this finding include viral hepatitis, healing fractures, and osteogenic sarcoma.	
3. 	This is incorrect. Severe anemia is associated with a decreased, not increased, ALP level.	
4. 	This is correct. Conditions associated with this finding include viral hepatitis, healing fractures, and osteogenic sarcoma.	
5. 	This is incorrect. Celiac disease is associated with a decreased, not increased, ALP level.	

PTS:	1	CON:	Digestion

	75.	ANS:	1, 3
Page: 17
Heading: Alkaline Phosphatase and Isoenzymes 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is correct. Increased ALP levels may be associated with liver disease. Dietary recommendations may be indicated and may vary depending on the severity of the condition. Patients should be encouraged to eat simple carbohydrates and emulsified fats (e.g., homogenized milk or eggs) rather than complex carbohydrates (e.g., starch, fiber, and glycogen [animal carbohydrates]).	
2. 	This is incorrect. Patients should be encouraged to eat simple carbohydrates and emulsified fats (e.g., homogenized milk or eggs) rather than complex carbohydrates (e.g., starch, fiber, and glycogen [animal carbohydrates]). Rice is a starch.	
3. 	This is correct. Patients should be encouraged to eat simple carbohydrates and emulsified fats (e.g., homogenized milk or eggs) rather than complex carbohydrates (e.g., starch, fiber, and glycogen [animal carbohydrates]).	
4. 	This is incorrect. Patients should be encouraged to eat simple carbohydrates and emulsified fats (e.g., homogenized milk or eggs) rather than complex carbohydrates (e.g., starch, fiber, and glycogen [animal carbohydrates]). Oat bran is a fiber.	
5. 	This is incorrect. Patients should be encouraged to eat simple carbohydrates and emulsified fats (e.g., homogenized milk or eggs) rather than complex carbohydrates (e.g., starch, fiber, and glycogen [animal carbohydrates]). Baked potato is a starch.	

PTS:	1	CON:	Nutrition

	76.	ANS:	1, 2, 4
Page: 19
Heading: Amylase 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is correct. Amylase is released from any damaged cell in which it is stored, so conditions that affect the pancreas and parotid glands and cause cellular destruction demonstrate elevated amylase levels. An increased amylase level is associated with biliary tract disease (related to impaired pancreatic duct flow).	
2. 	This is correct. An increased amylase level is associated with ectopic pregnancy (related to ectopic enzyme production by the fallopian tubes).	
3. 	This is incorrect. A decreased amylase level is associated with pancreatectomy (surgical removal of all or part of the pancreas).	
4. 	This is correct. An increased amylase level is associated with parotitis (related to increased secretion from inflamed tissue; salivary origin most likely).	
5. 	This is incorrect. A decreased amylase level is associated with toxemia of pregnancy.	

PTS:	1	CON:	Nutrition

	77.	ANS:	1, 3
Page: 25
Heading: Anticonvulsant Drugs: Carbamazepine, Ethosuximide, Lamotrigine, Phenobarbital, Phenytoin, Primidone, Valproic Acid 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies 
Cognitive Level: Application [Applying] 
Concept: Neurologic Regulation 
Difficulty: Moderate

	Rationale	
1.	This is correct. Anticonvulsants such as carbamazepine are used to reduce the frequency and severity of seizures for patients with epilepsy.	
2. 	This is incorrect. Antibiotics, not anticonvulsants, are used to fight off gram-negative bacteria.	
3. 	This is correct. Carbamazepine is used for controlling neurogenic pain in trigeminal neuralgia and diabetic neuropathy and for treating bipolar disease and other neurological and psychiatric conditions.	
4. 	This is incorrect. Immunosuppressants, not anticonvulsants, are used to suppress the immune system.	
5. 	This is incorrect. Statins, such as atorvastatin (Lipitor), are used to decrease blood cholesterol level, not anticonvulsants.	

PTS:	1	CON:	Neurologic Regulation

	78.	ANS:	3, 4, 5
Page: 25
Heading: Anticonvulsant Drugs: Carbamazepine, Ethosuximide, Lamotrigine, Phenobarbital, Phenytoin, Primidone, Valproic Acid 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Patient attitude would not affect the action of valproic acid.	
2. 	This is incorrect. Patient posture would not affect the action of valproic acid.	
3. 	This is correct. Many factors must be considered in effective dosing and monitoring of therapeutic drugs, including patient age.	
4. 	This is correct. Many factors must be considered in effective dosing and monitoring of therapeutic drugs, including patient weight.	
5. 	This is correct. Many factors must be considered in effective dosing and monitoring of therapeutic drugs, including protein levels.	

PTS:	1	CON:	Metabolism

	79.	ANS:	2, 3, 5
Page: 29
Heading: Antidepressant Drugs (Cyclic): Amitriptyline, Nortriptyline, Protriptyline, Doxepin, Imipramine 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies 
Cognitive Level: Application [Applying] 
Concept: Mood 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Cyclic antidepressants have not been used effectively to treat seizure disorder.	
2. 	This is correct. Cyclic antidepressants have been used effectively to treat bipolar disorder, panic disorder, attention deficit-hyperactivity disorder, obsessive-compulsive disorder, enuresis, eating disorders (bulimia nervosa in particular), nicotine dependence (tobacco), and cocaine dependence.	
3. 	This is correct. Cyclic antidepressants have been used effectively to treat panic disorder.	
4. 	This is incorrect. Cyclic antidepressants have not been used effectively to treat Asperger disorder.	
5. 	This is correct. Cyclic antidepressants have been used effectively to treat obsessive-compulsive disorder.	

PTS:	1	CON:	Mood

	80.	ANS:	1, 2, 4
Page: 35
Heading: Bilirubin and Bilirubin Fractions 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Hematologic Regulation 
Difficulty: Moderate

	Rationale	
1.	This is correct. Causes of prehepatic jaundice include hematoma, hemolytic anemia, and red blood cell enzyme abnormalities.	
2. 	This is correct. Causes of prehepatic jaundice include hematoma, hemolytic anemia, and red blood cell enzyme abnormalities.	
3. 	This is incorrect. Alcoholism is a hepatic cause of jaundice.	
4. 	This is correct. Causes of prehepatic jaundice include hematoma, hemolytic anemia, and red blood cell enzyme abnormalities.	
5. 	This is incorrect. Biliary obstruction is a cause of posthepatic jaundice.	

PTS:	1	CON:	Hematologic Regulation

	81.	ANS:	1, 5
Page: 35
Heading: Bilirubin and Bilirubin Fractions 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Hematologic Regulation 
Difficulty: Moderate

	Rationale	
1.	This is correct. Advanced tumor of the liver is a posthepatic cause of jaundice.	
2. 	This is incorrect. Hemolytic anemia is a prehepatic cause of jaundice.	
3. 	This is incorrect. Alcoholism is a hepatic cause of jaundice.	
4. 	This is incorrect. Red blood cell enzyme abnormalities are a prehepatic cause of jaundice.	
5. 	This is correct. Biliary obstruction is a posthepatic cause of jaundice.	

PTS:	1	CON:	Hematologic Regulation

	82.	ANS:	2, 3, 5
Page: 39
Heading: Calcium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Acute pancreatitis (a complication of pancreatitis related to hypoalbuminemia and calcium binding by excessive fats) is associated with decreased calcium level.	
2. 	This is correct. One cause of increased calcium level is acidosis (related to imbalance in electrolytes; longstanding acidosis can result in osteoporosis and release of calcium into circulation).	
3. 	This is correct. One cause of increased calcium level is leukemia.	
4. 	This is incorrect. Hepatic cirrhosis (related to impaired metabolism of vitamin D and calcium) is associated with decreased calcium level.	
5. 	This is correct. One cause of increased calcium level is dehydration (related to a decrease in the fluid portion of blood, causing an overall increase in the concentration of most plasma constituents).	

PTS:	1	CON:	Nutrition

	83.	ANS:	2, 3, 5
Page: 43
Heading: Carbon Dioxide 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Oxygenation 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Decreased, not increased, carbon dioxide level is associated with acute renal failure (response to buildup of ketoacids).	
2. 	This is correct. Increased carbon dioxide level is associated with airway obstruction (related to impaired elimination from weak breathing responses).	
3. 	This is correct. Increased carbon dioxide level is associated with pneumonia (related to impaired elimination from weak breathing responses).	
4. 	This is incorrect. Decreased, not increased, carbon dioxide level is associated with high fever (response to neutralize acidosis present during fever).	
5. 	This is correct. Increased carbon dioxide level is associated with pulmonary tuberculosis (related to impaired elimination from weak breathing responses).	

PTS:	1	CON:	Oxygenation

	84.	ANS:	1, 4
Page: 43
Heading: Carbon Dioxide 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: pH Regulation 
Difficulty: Moderate

	Rationale	
1.	This is correct. Decreased carbon dioxide level is associated with acute renal failure (response to buildup of ketoacids).	
2. 	This is incorrect. Increased, not decreased, carbon dioxide level is associated with airway obstruction (related to impaired elimination from weak breathing responses).	
3. 	This is incorrect. Increased, not decreased, carbon dioxide level is associated with pneumonia (related to impaired elimination from weak breathing responses).	
4. 	This is correct. Decreased carbon dioxide level is associated with high fever (response to neutralize acidosis present during fever).	
5. 	This is incorrect. Increased, not decreased, carbon dioxide level is associated with pulmonary tuberculosis (related to impaired elimination from weak breathing responses).	

PTS:	1	CON:	pH Regulation		

	85.	ANS:	2, 3, 5
Page: 46
Heading: Chloride, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: pH Regulation 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Blood chloride levels are increased, not decreased, in metabolic acidosis (associated with prolonged diarrhea).	
2. 	This is correct. Blood chloride levels are decreased in Addison’s disease (related to insufficient production of aldosterone; potassium is retained while sodium and chloride are lost).	
3. 	This is correct. Blood chloride levels are decreased in diabetic ketoacidosis (related to acid-base imbalance with accumulation of ketone bodies and increased chloride).	
4. 	This is incorrect. Blood chloride levels are increased, not decreased, in primary hyperparathyroidism (high chloride-to-phosphate ratio is used to assist in diagnosis).	
5. 	This is correct. Blood chloride levels are decreased in congestive heart failure (related to dilutional effect of fluid buildup).	

PTS:	1	CON:	pH Regulation		

	86.	ANS:	1, 4
Page: 46
Heading: Chloride, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: pH Regulation 
Difficulty: Moderate

	Rationale	
1.	This is correct. Blood chloride levels are increased in metabolic acidosis (associated with prolonged diarrhea).	
2. 	This is incorrect. Blood chloride levels are decreased, not increased, in Addison’s disease (related to insufficient production of aldosterone; potassium is retained while sodium and chloride are lost).	
3. 	This is incorrect. Blood chloride levels are decreased, not increased, in diabetic ketoacidosis (related to acid-base imbalance with accumulation of ketone bodies and increased chloride).	
4. 	This is correct. Blood chloride levels are increased in primary hyperparathyroidism (high chloride-to-phosphate ratio is used to assist in diagnosis).	
5. 	This is incorrect. Blood chloride levels are decreased, not increased, in congestive heart failure (related to dilutional effect of fluid buildup).	

PTS:	1	CON:	pH Regulation		

	87.	ANS:	1, 3
Page: 49
Heading: Cholesterol, HDL and LDL 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

	Rationale	
1.	This is correct. Increased HDL cholesterol is associated with alcoholism.	
2. 	This is incorrect. Decreased, not increased, HDL cholesterol is associated with chronic renal failure.	
3. 	This is correct. Increased HDL cholesterol is associated with chronic hepatitis.	
4. 	This is incorrect. Decreased, not increased, HDL cholesterol is associated with obesity.	
5. 	This is incorrect. Decreased, not increased, HDL cholesterol is associated with smoking.	

PTS:	1	CON:	Metabolism

	88.	ANS:	2, 4, 5
Page: 49
Heading: Cholesterol, HDL and LDL 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Increased, not decreased, HDL cholesterol is associated with alcoholism.	
2. 	This is correct. Decreased HDL cholesterol is associated with chronic renal failure.	
3. 	This is incorrect. Increased, not decreased, HDL cholesterol is associated with chronic hepatitis.	
4. 	This is correct. Decreased HDL cholesterol is associated with obesity.	
5. 	This is correct. Decreased HDL cholesterol is associated with smoking.	

PTS:	1	CON:	Metabolism

	89.	ANS:	2, 3
Page: 53
Heading: Cholesterol, Total 
Integrated Processes: Teaching and Learning 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. The patient need not refrain from exercise before the procedure.	
2. 	This is correct. The nurse should instruct the patient to fast 6 to 12 hours before specimen collection.	
3. 	This is correct. The nurse should instruct the patient to withhold alcohol 12 to 24 hours before specimen collection, as alcohol consumption can falsely elevate results.	
4. 	This is incorrect. The patient need not lie supine before the procedure. In fact, lower levels are obtained if the specimen is from a patient who has been supine for 20 minutes.	
5. 	This is incorrect. The patient need not sit upright before the procedure.	

PTS:	1	CON:	Perfusion

	90.	ANS:	1, 2, 4
Page: 56
Heading: C-Reactive Protein 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Inflammation 
Difficulty: Moderate

	Rationale	
1.	This is correct. CRP level is elevated in acute bacterial infection.	
2. 	This is correct. CRP level is elevated in Crohn’s disease.	
3. 	This is incorrect. CRP level is not elevated with sickle cell anemia.	
4. 	This is correct. CRP level is elevated in myocardial infarction.	
5. 	This is incorrect. CRP level is not elevated with epilepsy.	

PTS:	1	CON:	Inflammation		

	91.	ANS:	1, 2, 3
Page: 61
Heading: Creatinine, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

	Rationale	
1.	This is correct. Blood creatinine level is decreased in muscle atrophy (decreased muscle mass).	
2. 	This is correct. Blood creatinine level is decreased in hyperthyroidism (related to increased glomerular filtration rate [GFR]).	
3. 	This is correct. Blood creatinine level is decreased in pregnancy (related to increased GFR).	
4. 	This is incorrect. Blood creatinine level is increased, not decreased, in chronic renal failure (related to decreased urinary excretion).	
5. 	This is incorrect. Blood creatinine level is increased, not decreased, in shock (related to increased release from damaged muscle).	

PTS:	1	CON:	Urinary Elimination	

	92.	ANS:	1, 2
Page: 61
Heading: Creatinine, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

	Rationale	
1.	This is correct. Excessive exercise for 8 hours before the test may cause a transient increase in the creatinine level.	
2. 	This is correct. A diet high in meat can increase creatinine level.	
3. 	This is incorrect. High blood levels of glucose, associated with diabetes, can cause false decreases in creatinine, not increases.	
4. 	This is incorrect. Chronic renal failure would contribute to increased creatinine levels, but it would not lead to inaccurate results, as this is what the test is designed to evaluate.	
5. 	This is incorrect. The patient eating a meal 4 hours before blood collection would not affect creatinine level.	

PTS:	1	CON:	Urinary Elimination	

	93.	ANS:	1, 4
Page: 63
Heading: Glucose 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

	Rationale	
1.	This is correct. Symptoms of diabetes include increased urination (polyuria).	
2. 	This is incorrect. Increased hunger, not a loss of appetite, is a symptom of diabetes.	
3. 	This is incorrect. High blood pressure is not a symptom of diabetes.	
4. 	This is correct. Symptoms of diabetes include excessive thirst (polydipsia).	
5. 	This is incorrect. Symptoms of diabetes include unexplained weight loss, not gain.	

PTS:	1	CON:	Metabolism

	94.	ANS:	1, 3, 4
Page: 66
Heading: Glucose 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

	Rationale	
1.	This is correct. Instruct the patient and caregiver to report signs and symptoms of hypoglycemia (e.g., polyphagia, confusion, diaphoresis). Polyphagia or hunger is a symptom of both hyperglycemia and hypoglycemia. The patient’s blood sugar should be taken; the glucose level will be decreased in hypoglycemia and increased in hyperglycemia.	
2. 	This is incorrect. Polyuria is a symptom of hyperglycemia, not hypoglycemia. The patient’s blood sugar should be taken; the glucose level will be decreased in hypoglycemia and increased in hyperglycemia.	
3. 	This is correct. Instruct the patient and caregiver to report signs and symptoms of hypoglycemia (e.g., polyphagia, confusion, diaphoresis). Confusion, an altered mental state, is a symptom of hypoglycemia. The patient’s blood sugar should be taken; the glucose level will be decreased in hypoglycemia and increased in hyperglycemia.	
4. 	This is correct. Instruct the patient and caregiver to report signs and symptoms of hypoglycemia (e.g., polyphagia, confusion, diaphoresis). Diaphoresis or sweating is a symptom of hypoglycemia. The patient’s blood sugar should be taken; the glucose level will be decreased in hypoglycemia and increased in hyperglycemia.	
5. 	This is incorrect. Polydipsia is a symptom of hyperglycemia, not hypoglycemia. The patient’s blood sugar should be taken; the glucose level will be decreased in hypoglycemia and increased in hyperglycemia.	

PTS:	1	CON:	Metabolism

	95.	ANS:	1, 2, 4
Page: 68
Heading: Glycated Hemoglobin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Metabolism 
Difficulty: Moderate

	Rationale	
1.	This is correct. Glycated hemoglobin level is decreased in chronic blood loss (related to decreased concentration of red blood cell [RBC]-bound glycated hemoglobin due to blood loss).	
2. 	This is correct. Glycated hemoglobin level is decreased in chronic renal failure (low RBC count associated with this condition reflects corresponding decrease in RBC-bound glycated hemoglobin).	
3. 	This is incorrect. Glycated hemoglobin level is increased, not decreased, in diabetes (poorly controlled or uncontrolled, related to and evidenced by elevated glucose levels) and splenectomy (related to prolonged RBC survival, which extends the amount of time hemoglobin is available for glycosylation).	
4. 	This is correct. Glycated hemoglobin level is decreased in hemolytic anemia (evidenced by low RBC count due to hemolysis, reflecting a corresponding decrease in RBC-bound glycated hemoglobin).	
5. 	This is incorrect. Glycated hemoglobin level is increased, not decreased, in splenectomy (related to prolonged RBC survival, which extends the amount of time hemoglobin is available for glycosylation).	

PTS:	1	CON:	Metabolism

	96.	ANS:	2, 3, 4
Page: 70
Heading: Human Chorionic Gonadotropin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Pregnancy 
Difficulty: Difficult

	Rationale	
1.	This is incorrect. Creatinine, not HCG, is used to assess kidney function found in acute and chronic renal failure, related to drug reaction and disease such as diabetes.	
2. 	This is correct. HCG testing is used to assist in verification of pregnancy.	
3. 	This is correct. HCG testing is used to screen for neural tube defects.	
4. 	This is correct. HCG testing is used to evaluate HCG–secreting tumors.	
5. 	This is incorrect. The presence of C-reactive protein, not HCG, indicates a nonspecific inflammatory response; therefore, this highly sensitive test is used to assess risk for cardiovascular and peripheral artery disease.	

PTS:	1	CON:	Pregnancy

	97.	ANS:	2, 3, 4, 5
Page: 72
Heading: Human Chorionic Gonadotropin 
Integrated Processes: Communication and Documentation 
Client Need: Psychosocial Integrity 
Cognitive Level: Application [Applying] 
Concept: Pregnancy 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Decisions regarding elective abortion should take place in the presence of both parents.	
2. 	This is correct. The nurse should provide a nonjudgmental, nonthreatening atmosphere for discussion.	
3. 	This is correct. The nurse should discuss the risks and difficulties of delivering and raising a developmentally challenged infant.	
4. 	This is correct. The nurse should explore other options (e.g., termination of pregnancy or adoption).	
5. 	This is correct. The nurse should discuss feelings the mother and father may experience (e.g., guilt, depression, anger) if fetal abnormalities are detected.	

PTS:	1	CON:	Pregnancy

	98.	ANS:	3, 4
Page: 75
Heading: Immunosuppressants: Cyclosporine, Methotrexate, Everolimus, Sirolimus, and Tacrolimus 
Integrated Processes: Teaching and Learning 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Safety 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. The patient should not take NSAIDs while on this medication, as they can cause inaccuracy or lead to toxicity.	
2. 	This is incorrect. As cyclosporine is an immunosuppressant, given to patients to prevent rejection of an organ after transplantation, the patient should not be instructed to discontinue the medication for 6 weeks following an organ transplantation.	
3. 	This is correct. The nurse should tell the patient to avoid alcohol while on this medication.	
4. 	This is correct. The nurse should provide instructions regarding drug interactions.	
5. 	This is incorrect. The nurse should not instruct the patient to take the medication 30 minutes before eating.	

PTS:	1	CON:	Safety

	99.	ANS:	1, 3, 5
Page: 75
Heading: Immunosuppressants: Cyclosporine, Methotrexate, Everolimus, Sirolimus, and Tacrolimus 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Safety 
Difficulty: Moderate

	Rationale	
1.	This is correct. Signs and symptoms of cyclosporine toxicity include increased severity of expected side effects, which include nausea.	
2. 	This is incorrect. Signs and symptoms of cyclosporine toxicity include hypertension, not hypotension.	
3. 	This is correct. Signs and symptoms of cyclosporine toxicity include stomatitis.	
4. 	This is incorrect. Fever is not a sign or symptom of cyclosporine toxicity.	
5. 	This is correct. Signs and symptoms of cyclosporine toxicity include increased severity of expected side effects, which include seizures.	

PTS:	1	CON:	Safety

	100.	ANS:	3, 4, 5
Page: 78
Heading: Magnesium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Lipase, not magnesium, is needed for the digestion of fats.	
2. 	This is incorrect. Hemoglobin, not magnesium, is needed for the transport of oxygen in the bloodstream.	
3. 	This is correct. Magnesium is required as a cofactor in numerous crucial enzymatic processes, including protein synthesis.	
4. 	This is correct. Magnesium is required as a cofactor in numerous crucial enzymatic processes, including muscle contraction.	
5. 	This is correct. Magnesium is needed for the transmission of nerve impulses and muscle relaxation.	

PTS:	1	CON:	Fluid and Electrolyte Balance

	101.	ANS:	1, 3, 5
Page: 78
Heading: Magnesium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

	Rationale	
1.	This is correct. Serum magnesium level is increased in Addison’s disease, related to insufficient production of aldosterone and decreased renal excretion.	
2. 	This is incorrect. Serum magnesium level is decreased in alcoholism, related to increased renal excretion and possible insufficient dietary intake.	
3. 	This is correct. Serum magnesium level is increased in dehydration, related to hemoconcentration.	
4. 	This is incorrect. Serum magnesium level is decreased in pregnancy.	
5. 	This is correct. Serum magnesium level is increased in hypothyroidism (the pathophysiology is unclear).	

PTS:	1	CON:	Fluid and Electrolyte Balance

	102.	ANS:	1, 2, 4
Page: 79
Heading: Magnesium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is correct. Good dietary sources of magnesium include green vegetables, such as spinach.	
2. 	This is correct. Good dietary sources of magnesium include seeds, such as sunflower seeds.	
3. 	This is incorrect. Oranges are not known to be a good dietary source of magnesium.	
4. 	This is correct. Good dietary sources of magnesium include shrimp.	
5. 	This is incorrect. Chicken is not known to be a good dietary source of magnesium.	

PTS:	1	CON:	Nutrition

	103.	ANS:	2, 3, 4
Page: 82
Heading: Newborn Screening 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Pregnancy 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Every state and U.S. territory has a newborn screening program, which includes early hearing loss detection and intervention (EHDI). Thus, EHDI is a core test, not a confirmatory test.	
2. 	This is correct. Testing is categorized as core tests and second-tier tests. Confirmatory testing is performed if abnormal findings are produced by screening methods. Confirmatory testing varies depending on the initial screen and can include fatty acid oxidation probe tests on skin samples, enzyme uptake testing of skin or muscle tissue samples, enzyme assays of blood samples, DNA testing, gas chromatography/mass spectrometry, and tandem mass spectrometry.	
3. 	This is correct. Confirmatory testing can include fatty acid oxidation probe tests.	
4. 	This is correct. Confirmatory testing can include enzyme assays of blood samples.	
5. 	This is incorrect. Phenylketonuria is a core test, performed on all infants.	

PTS:	1	CON:	Pregnancy

	104.	ANS:	2, 3
Page: 92
Heading: Newborn Screening 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Pregnancy 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Most state regulations require screening specimens to be collected between 24 and 48 hours after birth to allow sufficient time after protein intake for abnormal metabolites to be detected, and preferably before blood product transfusion or physical transfer to another facility. Specimens for newborn screening collected earlier than 24 hours after the first feeding or collected from neonates receiving total parenteral nutrition may produce invalid results.	
2. 	This is correct. Blood specimens from neonates are collected by heel stick and applied to filter paper spots on the birth state’s specific screening program card.	
3. 	This is correct. Failure to let the filter paper sample dry may affect test results.	
4. 	This is incorrect. Specimens are preferably collected before blood product transfusion or physical transfer to another facility. Specimens for newborn screening collected after transfusion may produce invalid results.	
5. 	This is incorrect. Touching blood spots on the filter paper card after collection may contaminate the sample and produce invalid results.	

PTS:	1	CON:	Pregnancy

	105.	ANS:	1, 3, 4
Page: 102
Heading: Potassium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

	Rationale	
1.	This is correct. Normal potassium level is 3.5 to 5.0 mEq/L. Symptoms of hypokalemia include malaise, thirst, polyuria, anorexia, weak pulse, low blood pressure, vomiting, decreased reflexes, and electrocardiographic changes (depressed T waves and ventricular ectopy).	
2. 	This is incorrect. Normal potassium level is 3.5 to 5.0 mEq/L. Symptoms of hyperkalemia include irritability, diarrhea, cramps, oliguria, difficulty speaking, and cardiac arrhythmias (peaked T waves and ventricular fibrillation).	
3. 	This is correct. Normal potassium level is 3.5 to 5.0 mEq/L. Symptoms of hypokalemia include malaise, thirst, polyuria, anorexia, weak pulse, low blood pressure, vomiting, decreased reflexes, and electrocardiographic changes (depressed T waves and ventricular ectopy).	
4. 	This is correct. Normal potassium level is 3.5 to 5.0 mEq/L. Symptoms of hypokalemia include malaise, thirst, polyuria, anorexia, weak pulse, low blood pressure, vomiting, decreased reflexes, and electrocardiographic changes (depressed T waves and ventricular ectopy).	
5. 	This is incorrect. Normal potassium level is 3.5 to 5.0 mEq/L. Symptoms of hyperkalemia include irritability, diarrhea, cramps, oliguria, difficulty speaking, and cardiac arrhythmias (peaked T waves and ventricular fibrillation).	

PTS:	1	CON:	Fluid and Electrolyte Balance

	106.	ANS:	1, 2, 3
Page: 100
Heading: Potassium, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Fluid and Electrolyte Balance 
Difficulty: Moderate

	Rationale	
1.	This is correct. Potassium is increased in acute renal failure (potassium excretion is diminished, and it accumulates in the blood).	
2. 	This is correct. Potassium is increased in ketoacidosis (insulin deficiency results in movement of potassium from the cell into the extracellular fluid).	
3. 	This is correct. Potassium is increased in near drowning.	
4. 	This is incorrect. Potassium is decreased in congestive heart failure (related to fluid retention and hemodilution).	
5. 	This is incorrect. Potassium is decreased in anorexia nervosa (related to significant changes in renal function that result in hypokalemia).	

PTS:	1	CON:	Fluid and Electrolyte Balance

	107.	ANS:	2, 3, 5
Page: 104
Heading: Prealbumin 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Prealbumin level is decreased in diseases of the liver (related to decreased ability of the damaged liver to synthesize protein).	
2. 	This is correct. Prealbumin level is increased in alcoholism (related to leakage of prealbumin from damaged hepatocytes and/or poor nutrition).	
3. 	This is correct. Prealbumin level is increased in chronic renal failure (related to rapid turnover of prealbumin, which reflects a perceived elevation in the presence of overall loss of other proteins that take longer to produce).	
4. 	This is incorrect. Prealbumin level is decreased in malnutrition (synthesis is decreased due to lack of proper diet).	
5. 	This is correct. Prealbumin level is increased in patients receiving steroids (these drugs stimulate production of prealbumin).	

PTS:	1	CON:	Nutrition

	108.	ANS:	1, 3, 5
Page: 106
Heading: Protein, Blood, Total and Fractions 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is correct. Total protein level is increased in dehydration (related to hemoconcentration).	
2. 	This is incorrect. Total protein level is decreased in burns (related to fluid retention, loss of albumin from chronic open burns).	
3. 	This is correct. Total protein level is increased in myeloma (related to excessive g-globulin protein synthesis).	
4. 	This is incorrect. Total protein level is decreased in cirrhosis (related to damaged liver, which cannot synthesize adequate amount of protein).	
5. 	This is correct. Total protein level is increased in tropical diseases (e.g., leprosy) (related to inflammatory reaction).	

PTS:	1	CON:	Nutrition

	109.	ANS:	2, 5
Page: 111
Heading: Testosterone, Total 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Male Reproduction 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Smoking is not associated with decreased testosterone level.	
2. 	This is correct. Excessive alcohol intake is a cause of decreased testosterone level because alcohol inhibits the secretion of testosterone.	
3. 	This is incorrect. A sedentary lifestyle is not known to be a cause of decreased testosterone level.	
4. 	This is incorrect. Depression is not known to be associated with a decreased testosterone level.	
5. 	This is correct. Malnutrition is associated with a decreased testosterone level.	

PTS:	1	CON:	Male Reproduction	

	110.	ANS:	1, 2, 4, 5
Page: 115
Heading: Thyroxine, Free 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Metabolism 
Difficulty: Difficult

	Rationale	
1.	This is correct. The advantage of measuring free T4 instead of total T4 is that, unlike total T4 measurements, free T4 levels are not affected by fluctuations in TBG levels.	
2. 	This is correct. Free T4 levels are considered the most accurate indicator of T4 and its thyrometabolic activity.	
3. 	This is incorrect. Free T4 is a complementary, not first-line, laboratory test used in evaluating thyroid hormone levels related to deficiency or excess to assist in diagnosing hyperthyroidism and hypothyroidism.	
4. 	This is correct. Free T4 measurements are useful in evaluating thyroid disease when TSH levels alone provide insufficient information.	
5. 	This is correct. Measurement of free T4 is recommended during treatment for hyperthyroidism until symptoms have abated and levels have decreased into the normal range.	

PTS:	1	CON:	Metabolism

	111.	ANS:	1, 2, 4
Page: 118
Heading: Triglycerides 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

	Rationale	
1.	This is correct. Increased TGs are associated with alcoholism, related to decreased breakdown of fats in the liver and increased blood levels.	
2. 	This is correct. Increased TGs are associated with hypertension.	
3. 	This is incorrect. Decreased TGs are associated with end-stage liver disease, related to cessation of liver function that results in decreased production of TG and TG transport proteins.	
4. 	This is correct. Increased TGs are associated with obesity.	
5. 	This is incorrect. Decreased TGs are associated with hyperthyroidism, related to increased catabolism of very low–density lipoprotein transport proteins and general increase in metabolism.	

PTS:	1	CON:	Perfusion

	112.	ANS:	3, 4
Page: 119
Heading: Triglycerides 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Perfusion 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. There is no need for the patient to avoid exercise before the test.	
2. 	This is incorrect. There is no need for the patient to discontinue hypertension medication before the test.	
3. 	This is correct. The patient should be on a stable diet for 3 weeks before specimen collection.	
4. 	This is correct. The patient should avoid alcohol consumption for 3 days before the test. 	
5. 	This is incorrect. The patient should fast for 12 hours, not 2 hours, before specimen collection.	

PTS:	1	CON:	Perfusion

	113.	ANS:	2, 3, 5
Page: 123
Heading: Urea Nitrogen, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. BUN level is decreased in inadequate dietary protein (urea nitrogen is a by-product of protein metabolism; less available protein is reflected in decreased BUN levels).	
2. 	This is correct. BUN level is increased in acute renal failure (related to decreased renal excretion).	
3. 	This is correct. BUN level is increased in congestive heart failure (related to decreased blood flow to the kidneys, decreased renal excretion, and accumulation in circulating blood).	
4. 	This is incorrect. BUN level is decreased in pregnancy.	
5. 	This is correct. BUN level is increased in muscle wasting from starvation (related to increased protein metabolism).	

PTS:	1	CON:	Urinary Elimination	

	114.	ANS:	1, 3, 5
Page: 124
Heading: Urea Nitrogen, Blood 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Urinary Elimination 
Difficulty: Moderate

	Rationale	
1.	This is correct. A BUN level greater than 100 mg/dL in adults is a critical finding. Possible interventions include treatment of the cause, administration of IV bicarbonate, a low-protein diet, hemodialysis, and caution with respect to prescribing and continuing nephrotoxic medications.	
2. 	This is incorrect. Continuation of nephrotoxic medications may be contraindicated in a patient with a critically high BUN level.	
3. 	This is correct. A low-protein diet is an appropriate intervention for a patient with a critically high BUN level.	
4. 	This is incorrect. Contrast media used with CT scans can be nephrotoxic and may be contraindicated in a patient with a critically high BUN level.	
5. 	This is correct. Hemodialysis may be required for a patient with a critically high BUN level.	

PTS:	1	CON:	Urinary Elimination	

	115.	ANS:	1, 2, 4
Page: 126
Heading: Vitamin D 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is correct. A decreased vitamin D level is associated with celiac disease, related to lack of absorption.	
2. 	This is correct. A decreased vitamin D level is associated with osteomalacia, related to dietary insufficiency.	
3. 	This is incorrect. A decreased vitamin C, not vitamin D, level is associated with scurvy.	
4. 	This is correct. A decreased vitamin D level is associated with rickets, related to dietary insufficiency.	
5. 	This is incorrect. A decreased vitamin K, not vitamin D, level is associated with cardiac dysrhythmias.	

PTS:	1	CON:	Nutrition

	116.	ANS:	2, 3
Page: 126
Heading: Vitamin D 
Integrated Processes: Teaching and Learning 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Application [Applying] 
Concept: Nutrition 
Difficulty: Moderate

	Rationale	
1.	This is incorrect. Citrus fruits are an excellent source of vitamin C but not of vitamin D.	
2. 	This is correct. The main dietary sources of vitamin D are fortified dairy foods and cod liver oil.	
3. 	This is correct. The main dietary sources of vitamin D are fortified dairy foods and cod liver oil.	
4. 	This is incorrect. Dark green, leafy vegetables are not a good dietary source of vitamin D.	
5. 	This is incorrect. Lean beef is not a good dietary source of vitamin D.	

PTS:	1	CON:	Nutrition

ORDERED RESPONSE

	117.	ANS:	
5, 1, 4, 3, 2
Rationale: The five basic components of the nursing process are as follows: assessment, diagnosis, planning, implementation, and evaluation.

Page: 8
Heading: Drug Levels 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Analysis [Analyzing] 
Concept: Critical Thinking 
Difficulty: Moderate

PTS:	1	CON:	Critical Thinking	

	118.	ANS:	
5, 1, 4, 6, 3, 2
Rationale: The steps for performing an air conduction hearing test on an infant are as follows: (1) Perform an otoscopy examination to ensure external ear canal is free from obstruction. (2) Apply electrodes to the scalp and place earphones in the ears. (3) Deliver a tone at 1,000 Hz. (4) Decrease the intensity 10 dB at a time until there is no response. (5) Increase the intensity 5 dB at a time until the tone is heard. (6) Repeat the process until the same response is achieved at a 50% response rate at the same hertz level.

Page: 94
Heading: Newborn Screening 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Sensory Perception 
Difficulty: Difficult

PTS:	1	CON:	Sensory Perception	

	119.	ANS:	
C, 1, 6, 5, 2, 4
Rationale: The steps for collecting a blood specimen for a filter paper test on a neonate are as follows: (1) Cleanse the infant’s heel with an antiseptic. (2) Perform a heel stick. (3) Gently squeeze the infant’s heel. (4) Touch the filter paper to the puncture site. (5) Use gauze to dry the stick area completely. (6) Allow the card to air dry for several hours.

Page: 94
Heading: Thyroid-Stimulating Hormone 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity: Reduction of Risk Potential 
Cognitive Level: Analysis [Analyzing] 
Concept: Metabolism 
Difficulty: Moderate

PTS:	1	CON:	Metabolism