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The practical nurse (PN) reviews the laboratory results of an elderly female client who is one day postoperative for a right total hip replacement (THR).

Which serum value result has the greatest implication for client safety?

Reference ranges

  • Hemoglobin (Hgb) [12 to 16 g/dL (120 to 160 g/L)]
  • Potassium (K+) [3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]
  • Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]
  • Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]

A.

Sodium 130 mEq/L.

B.

Hemoglobin 8.9 grams/dL.

C.

Potassium 3.4 mEq/L

D.

Blood urea nitrogen 20 mg/dL.

Answer and Explanation

The Correct Answer is B

A.    Sodium level of 130 mEq/L is slightly below the lower limit of the reference range but might not have as immediate an impact on safety as a critically low hemoglobin level. 
B.    Hemoglobin of 8.9 grams/dL is significantly below the normal range and indicates a substantial drop in red blood cells, which can lead to impaired oxygen transport and potentially severe postoperative complications like inadequate tissue perfusion and oxygenation. 
C.    Potassium level of 3.4 mEq/L is slightly below the lower limit of the reference range but might not pose an immediate threat compared to a critically low hemoglobin level. 
D.    Blood urea nitrogen (BUN) of 20 mg/dL is at the upper limit of the reference range but might not have an immediate implication for client safety compared to a critically low hemoglobin level. 
 


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Related Questions

Correct Answer is D

Explanation

A. Ask about pain. This is not the most important action because pain is not the primary problem in this situation. Pain may or may not be present, but it does not address the underlying cause of cyanosis.

B. Provide mouth care. This is not the most important action because mouth care does not improve oxygenation. Mouth care may be helpful to prevent infection and promote comfort, but it is not a priority in this case.

C. Offer fluids. This is not the most important action because fluids do not increase oxygen levels in the blood. Fluids may be beneficial to prevent dehydration and maintain circulation, but they are not urgent in this scenario.

D. Administer oxygen. This is the most important action because oxygen is essential for cellular function and survival. Oxygen therapy can reverse hypoxia and improve the client's condition.

Correct Answer is C

Explanation

A. Write an incident report about the bruises on the infant. - These areas might not be bruises; hence, writing an incident report without accurate information could be premature.
B. Review the labor and delivery record for birth trauma. - While important, it might not directly relate to the observed bluish-black areas.
C. Record the size and location of the areas in the infant's chart. - Documenting the observations is essential for tracking changes and informing other healthcare providers.
D. Notify the pediatrician of a possible bleeding problem with the infant. - Without further assessment, assuming a bleeding problem might be premature and unnecessarily alarming.

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