NCLEX Practice Exam for Laboratory Values

Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam.

Exam Mode – Questions and choices are randomly arranged, time limit of 1min  per question, answers and grade will be revealed after finishing the exam.

Text Mode – Text version of the exam

1. A client with Congestive heart failure is about to take a dose of furosemide (Lasix). Which of the following potassium level, if noted in the client’s record, should be reported before giving the due medication?

1. 5.1 mEq/L.
   
2. 4.9 mEq/L.
   
3. 3.9 mEq/L.
   
4. 3.3 mEq/L.

2. A client went to the emergency room with sudden onset of high fever and diaphoresis. Serum sodium was one of the laboratory test taken. Which of the following values would you expect to see?

1. 130 mEq/L.
2. 148 mEq/L.
3. 143 mEq/L.
4. 139 mEq/L.

3. A client is brought to the emergency department states that he has accidentally been taking two times his prescribed dose of Warfarin (Coumadin). After observing that the client has no evidence of any obvious bleeding, the nurse should do which of the following?

1. Draw a sample for activated partial thromboplastin time (aPTT) level.
2. Draw a sample for prothrombin time (PT) level and international normalized ratio (INR).
3. Prepare to administer Vitamin K.
4. Prepare to administer Protamine sulfate.

4. A male client with atrial fibrillation who is receiving maintenance therapy of warfarin (Coumadin) has a prothrombin time of 37 seconds. Based on the result, the nurse will follow which of the following doctor’s order?

1. Administering the next dose of the warfarin.
2. Increasing the next dose of warfarin.
3. Decreasing the next dose of warfarin.
4. Withholding the next dose of warfarin.

5. A client is receiving a continuous intravenous infusion of heparin sodium to treat deep vein thrombosis. The client’s activated partial thromboplastin time is 77 seconds. Based on this result, the nurse anticipate which of the following prescription?

1. Maintain the rate of the heparin infusion.
2. Decrease the rate of the heparin infusion.
3. Increase the rate of the heparin infusion.
4. Discontinue the heparin infusion.

6. A nurse is handling a pregnant client who was prescribed to have an Alpha Feta Protein level. The nurse should explain to the client that this blood test:

1. Can indicate lung disorders and neural tube defects.
   
2. Abnormal levels are associated with an increased risk for chromosome abnormality.
3. Once the Alpha Feta Protein levels are abnormal, an amniocentesis will be ordered.
4. An Alpha Feta Protein is a definitive test for neural tube defects.

7. Which of the following laboratory results indicates hypoparathyroidism?

1. Serum potassium of 3.6 mEq/L.
   
2. Serum calcium level of 4.3 mEq/L.
   
3. Serum phosphorus level of 5.7 mg/dL.
   
4. Serum magnesium level of 1.7 mg/dL.

8. An adult male client has a hemoglobin count of 12.5 g/dL. Based on the result, the client is most likely having this due to which of the following noted in the client’s record?

1. Emphysema.
2. Client living at a high altitude.
3. Dehydration.
4. History of an enlarged spleen.

9. A screen test for detection of human immunodeficiency virus (HIV) reveals a positive ELISA exam. Which of the following test will be used to confirm the diagnosis of HIV?

1. Indirect immunofluorescence assay (IFA).
   
2. CD4-to-CD8 ratio.
3. Radioimmunoprecipitation assay (RIPA) test.
   
4. p24 antigen assay.

10. The client went to the emergency room with a sudden onset of chest pain and difficulty of breathing. Which of the following result is indicative that the client is experiencing a myocardial infarction?

1. Myoglobin level of 98 mcg/L.
2. Troponin T of 0.09 ng/mL.
   
3. Troponin I 0.5 ng/mL.
4. Creatine kinase (CK-MB) 155 units/L.

11. A nurse is caring for a client with diarrhea and dehydration. The nurse determines that the client has received adequate fluid replacement if the blood urea nitrogen decreases to:

1. 36 mg/dL.
2. 27 mg/dL.
3. 18 mg/dL.
4. 6 mg/dL.

12. A client with liver cirrhosis has been advised to follow a high-protein diet. The nurse evaluates the effectiveness of the diet if the total protein level is which of the following values?

1. 6.9 g/dL.
2. 4.9 g/dL.
3. 2.9 g/dL.
4. 0.9 g/dL.

13. The nurse is handling a client with chronic pancreatitis. Upon reviewing the client’s record, which of the following serum amylase level is to be expected?

1. 50 units/L.
2. 150 units/L.
3. 350 units/L.
4. 650 units/L.

14. A client with diabetes mellitus has a glycosylated hemoglobin A1c level of 10%. Based on the result, the nurse plans to teach the client about the importance of:

1. Maintaining the result.
2. Preventing hypoglycemia.
3. Preventing hyperglycemia.
4. Avoiding infection.

15. The nurse is reviewing the laboratory result of a client receiving digoxin (Lanoxin) and notes that the result is 2.5 ng/mL. The nurse plans to do which of the following?

1. Give the next dose.
2. Notify the physician.
3. Check the client’s pulse rate.
4. Increase the next dose as ordered.
   

16. The nurse caring for a client with a serum calcium of 6.8 mg/dL. What would the nurse expect the change on the electrocardiogram (ECG)?

1. None. This is a normal calcium level.
2. Prolonged QT interval.
3. Shortened ST segment.
4. Widened T wave.

17. When providing care for a female client with Addison disease, the nurse should be alert for which of the following laboratory value?

1. Potassium level of 3.2 mEq/L.
2. Calcium level of 3.3 mEq/L.
3. Sodium level of 150 mg/dL.
4. Hematocrit level of 25%.

18. A client has been undergoing radiotherapy for the treatment of mandibular cancer. After a few sessions, the client is diagnosed with Tumor Lysis Syndrome (TLS). Which of the following findings correlates with TLS?

1. Phosphorus level of 6 mg/dL.
2. Phosphorus level of 3 mg/dL.
3. Phosphorus level of 4 mg/dL.
4. Phosphorus level of 2 mg/dL.

19. A female client went to the clinic with a creatine clearance of 200 mL/min. Which of the following condition of the client can cause the increased level of this test?

1. Renal disease.
2. Dehydration.
3. Congestive heart failure.
4. History of high dietary protein intake.

20. A nurse is reviewing the complete blood count (CBC) of a child who has been diagnosed with idiopathic thrombocytopenic purpura. Which of the following laboratory result should the nurse report immediately to the physician?

1. Platelet count of 30,000/mm3.
2. Hemoglobin level of 7.5 g/dL.
3. Reticulocyte count of 6.5%.
4. Eosinophil count of 700 cells/mm3.

Answers and Rationale

1. Answer: D. 3.3 mEq/L. The normal potassium level is 3.5 to 5.5 mEq/L. Low potassium levels can be dangerous, especially for people with CHF. Low potassium can cause fatal heart arrhythmias.

2. Answer: B. 148 mEq/L. The normal sodium level is 135-145 mEq/L. Diaphoresis and a high fever can lead to free water loss through the skin, resulting in increased sodium level (hypernatremia).

3. Answer: B. Draw a sample for prothrombin time (PT) level and international normalized ratio (INR). The next action for the nurse to take is to draw a sample for INR and PT level to check the client’s anticoagulation status and risk for bleeding. These results will provide information on how to manage the client either giving an antidote such as Vitamin K or administering a blood transfusion.

• Option A: The aPTT determines the effects of heparin therapy.
• Option C: The results of the INR and PT level will be needed first.
• Option D: Protamine sulfate is the antidote for heparin overdose.

4. Answer: D. Withholding the next dose of warfarin. The normal prothrombin time is 9.6 to 11.8 seconds (male adult). A therapeutic level PT level is 1.5 to 2 times higher than the normal level. Since the value of 37 seconds is high, the nurse should expect that the client next dose of warfarin will be withheld.

5. Answer: A. Maintain the rate of the heparin infusion. The normal activated partial thromboplastin time is between 20 to 36 seconds. In the treatment of deep vein thrombosis, the therapeutic range is to maintain the aPTT level between 1.5 and 2.5 times the normal. This means that the client’s aPTT level should not be less 30 seconds or greater than 90 seconds. Thus the client’s aPTT of 77 seconds is within the normal therapeutic range, and the dose/rate should not be changed.

6. Answer: C. Once the Alpha Feta Protein levels are abnormal, an amniocentesis will be ordered. If the Alpha Feta Protein levels are abnormal, the physician will prescribe an amniocentesis to confirm or eliminate the diagnosis of a neural tube defect.

• Option A is incorrect since Alpha Feta Protein does not indicate lung disorders.
• Option B is incorrect because an increase of human chorionic gonadotropin instead is associated with an increased risk for chromosome abnormality.
• Option D is incorrect because an Alpha Feta Protein level is a screening test and is not a definitive test.

7. Answer: C. Serum phosphorus level of 5.7 mg/dL. The parathyroid is responsible for the absorption of calcium and phosphorus. When a client has hypoparathyroidism, the serum calcium levels are low and the serum phosphorus levels are high. The normal phosphorus level is 2.7 to 4.5 mg/dL.

8. Answer: D. History of splenomegaly. The normal hemoglobin level for an adult male is 14-16.5 g/dL. An enlarged spleen may cause anemia (low hemoglobin count) in clients.

• Options A and B: Emphysema and living at higher altitudes causes the red blood cell production to naturally increases to compensate for the lower oxygen supply.
• Option C: Dehydration may increase the hemoglobin level by hemoconcentration.

9. Answer: A. Indirect immunofluorescence assay (IFA) The indirect immunofluorescence assay (IFA) test and Western Blot test result are considered as confirmatory for HIV.

• Option B: CD4-to-CD8 ratio monitors the progression of HIV.
• Option C: Radioimmunoprecipitation assay (RIPA) test detects HIV protein rather than showing antibodies.
• Option D: p24 antigen assay quantifies the amount of HIV viral core protein.

10. Answer: A. Myoglobin level of 98 mcg/L. The normal value of myoglobin is lower than 90 mcg/L; An elevation could indicate a myocardial infarction.

• Options B, C, and D all have normal values.

11. Answer: C. 18 mg/dL. The normal value of blood urea nitrogen is 8 to 25 mg/dL.

• Options A and B still indicates dehydration.
• Option D which has a low BUN occurs with conditions such as fluid volume overload, malnutrition, etc.

12. Answer: A. 6.9 g/dL. The normal value for total serum protein is 6 to 8 g/dL. The client with liver cirrhosis has low total protein levels secondary to inadequate nutrition.

• Options B, C, and D are abnormal values.

13. Answer: C. 350 units/L. The normal serum amylase level is 25 to 151 unit/L. Clients with chronic pancreatitis have an increased level of serum amylase which does not exceed three times the normal value.

• Options A and B are within the normal values.
• Option D is seen with acute pancreatitis since the value may exceed five times the normal value.

14. Answer: C. Preventing hyperglycemia. Glycosylated hemoglobin A1c level of 8% higher indicates a poor diabetic control. Elevations indicate continued need for a teaching related to the prevention of hyperglycemic episodes.

15. Answer: B. Notify the physician. The normal value therapeutic range for digoxin is 0.5 to 2 ng/mL. A level of 2.5 ng/mL indicates a toxicity. The nurse should immediately inform the physician, who may give further instructions about holding the next doses of digoxin.

16. Answer: B. Prolonged QT interval. The normal serum calcium level is 8.6 to 10 mg/dL. A serum calcium level lower than 8.6 mg/dL indicates hypocalcemia. Electrocardiographic changes that occur in a client with hypocalcemia include a prolonged ST or QT interval.

• Options C and D: A shortened ST segment and a widened T wave occur with hypercalcemia.

17. Answer: D. Hematocrit level of 25%. A client with Addison’s disease is at risk for anemia. The normal hematocrit level of a female adult is 35% to 45%. A client with anemia has a low hematocrit level.

• Options A and B: Client with Addison’s disease have an increased potassium and calcium level.
• Option C: Client with Addison’s disease have a low sodium level.

18. Answer: A. Phosphorus level of 6 mg/dL. Tumor lysis syndrome (TLS) is a potentially life-threatening metabolic disorder characterized by elevated phosphorus levels. The normal phosphorus is 2.5 to 4.5 mg/dL.

19. Answer: D. History of high dietary protein intake. The normal creatine clearance for a female is 88 to 128 ml/min. An increased creatinine clearance is often referred to as hyperfiltration and is most commonly seen during pregnancy or in clients with a large dietary protein intake.

• Options A, B, and C are seen with a decreased creatinine clearance.

20. Answer: B. Hemoglobin level of 7.5 g/dL. The low hemoglobin level indicates that the client has an active bleeding, and immediate actions such as additional diagnostic exam and blood transfusions can be suggested.

• Options A, C, and D: Decreased platelet count, increased reticulocyte and increased eosinophil count are expected in a child with idiopathic thrombocytopenic purpura.