A nurse is reviewing the laboratory results for a client who has Cushing's disease. The nurse should expect the client to have an increase in which of the following laboratory values?

Serum calcium level

Lymphocyte count

Serum glucose level

Serum potassium level

Answer and Explanation

The Correct Answer is C

Rationale:

A. Serum calcium level: Cushing’s disease does not typically cause elevated calcium levels. Calcium levels are usually normal unless there is an underlying bone disorder or concurrent condition affecting calcium metabolism.

B. Lymphocyte count: Cortisol excess in Cushing’s disease suppresses the immune system, leading to lymphopenia rather than an increased lymphocyte count. A decreased lymphocyte count is more consistent with the disease process.

C. Serum glucose level: Elevated cortisol levels increase gluconeogenesis and decrease glucose uptake by cells, resulting in hyperglycemia. Clients with Cushing’s disease often exhibit elevated blood glucose as a direct effect of excess cortisol.

D. Serum potassium level: Cortisol has mineralocorticoid activity, promoting potassium excretion by the kidneys. As a result, clients with Cushing’s disease commonly have hypokalemia rather than increased serum potassium levels.

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Correct Answer is ["B","C","E"]

Explanation

Rationale:

A. Prime the infusion tubing with 0.45% sodium chloride.: Blood products should never be primed with hypotonic solutions like 0.45% sodium chloride because it can cause hemolysis of the RBCs. Only 0.9% sodium chloride (normal saline) is safe for priming and flushing blood administration tubing.

B. Assess the client's lung sounds prior to the infusion.: Older adults are at increased risk for fluid overload during transfusions. Assessing lung sounds before starting the infusion provides a baseline and helps detect early signs of pulmonary edema or transfusion-associated circulatory overload.

C. Verify with another nurse that the unit of blood is compatible with the client's blood type.: Performing a second verification with another nurse is a critical safety measure to prevent transfusion reactions. Confirming blood type and crossmatch ensures compatibility and patient safety.

D. Don sterile gloves to prepare the blood administration setup.: Sterile gloves are not required for blood administration. Standard clean technique with non-sterile gloves is sufficient to prevent infection, as the IV setup does not require sterility.

E. Infuse the blood over 4 hr.: Red blood cells should be infused within 4 hours to minimize the risk of bacterial growth and ensure product viability. Infusing too slowly can increase infection risk, and infusing too quickly can cause fluid overload, especially in older adults.

A. Calcium B. Potassium C. Ammonia D. Glucose

Correct Answer is C

Explanation

Rationale:

A. Calcium: While calcium is important for many bodily functions, it is not a primary indicator for monitoring hepatic encephalopathy. Calcium imbalances do not directly correlate with the severity or management of this condition.

B. Potassium: Potassium levels are important for overall electrolyte balance, but they are not specific to hepatic encephalopathy. Monitoring potassium is part of routine care but does not indicate the progression or severity of encephalopathy.

C. Ammonia: Elevated ammonia levels are a key contributor to hepatic encephalopathy. The liver normally converts ammonia to urea, and when liver function is impaired, ammonia accumulates, affecting neurological function. Monitoring ammonia helps assess severity and guide treatment interventions.

D. Glucose: While glucose monitoring is important in general care, it is not specific to hepatic encephalopathy. Hyper- or hypoglycemia may occur with liver disease but does not directly reflect the presence or progression of encephalopathy.

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A nurse is reviewing the laboratory results for a client who has Cushing's disease. The nurse should expect the client to have an increase in which of the following laboratory values?

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