Lab Values for NCLEX-RN
Introduction
- Mark Klimek, a registered nurse, will discuss lab values for the NCLEX-RN exam.
- Lab values are often seen as challenging due to memorization and varying ranges across resources.
- The NCLEX will present lab values that are clearly within or outside the normal range, avoiding borderline cases.
Prioritizing Lab Values
- The exam will provide four abnormal lab values and require prioritization.
- A method exists to prioritize lab abnormalities without extensive memorization.
Lecture Outline
- The lecture is structured in three columns:
- Test/Lab Value
- Range (Ballpark, generally accepted)
- Prioritization
Key to Prioritization
- A, B, C, and D are used to indicate the priority of lab abnormalities.
- Important: These letters are for this lecture only and not recognized by NCLEX.
Priority Levels
- A - Abnormal:
- The lab value is abnormal, but not critical.
- No immediate action is required.
- B - Be Concerned:
- The lab value is concerning.
- No immediate action is required, but the nurse should be aware and monitor for potential causes.
- C - Critical:
- The lab value is critical, and action must be taken.
- The healthcare provider needs to be notified eventually.
- D - Deadly/Dangerous:
- The lab value is deadly dangerous and requires immediate action.
- The nurse cannot handle it alone and must call for help.
- Assess the patient's alertness and orientation before calling for help.
Specific Lab Values
Creatinine
- Third best indicator of kidney function.
- Best: Glomerular Filtration Rate (GFR)
- Second best: 24-hour creatinine clearance (urine test)
- Range: 0.6 to 1.2 (same numbers as lithium therapeutic level, but unrelated)
- Prioritization: A
- Elevated creatinine indicates a kidney issue, but is not immediately life-threatening.
- A high creatinine is only of immediate importance if the patient is scheduled for a test with contrast dye, as the kidneys excrete the dye.
PT INR
- Used to monitor warfarin (Coumadin) therapy.
- Range: 2s and 3s are desired for patients on warfarin (proper anticoagulation).
- Prioritization:
- 4 and above: C
- Hold all warfarin.
- Assess for bleeding.
- Prepare to administer vitamin K (the antidote).
- Call the health care provider.
- 4 and above: C
Potassium (K+)
- Range: 3.5 to 5.0 or 5.3 (upper limit varies slightly; NCLEX will not use borderline numbers)
- Prioritization:
- High (in the 5s): C
- Hold all potassium.
- If potassium IV is running, stop it.
- Assess the heart (ECG changes).
- Prepare to administer:
- Dextrose 5% with Regular Insulin (D5W with Regular Insulin) in two different IV sites
- Kayexalate
- Albuterol
- 6.0 and higher: D
- Everything listed above must be done immediately and simultaneously.
- Assess patient's alertness and orientation; call for help.
- High (in the 5s): C
pH
- Range: 7.35 to 7.45 (no debate on these numbers)
- NCLEX focuses on low pH (acidosis).
- Prioritization:
- pH in the 6s or lower: D
- Assess vital signs.
- Call the health care provider immediately.
- pH in the 6s or lower: D
Blood Urea Nitrogen (BUN)
- Waste product.
- Range: Approximately 8 to 30 (varies among resources)
- Prioritization: B
- Elevated BUN indicates dehydration.
Hemoglobin (Hgb)
- Range: 12 to 18 (slight gender difference, but NCLEX will not test on borderline numbers)
- NCLEX usually tests low hemoglobin levels.
- Prioritization:
- 8 to 11: B
- Assess for bleeding.
- Below 8: C
- Transfuse blood. (This may change in the future to below 7, but for this NCLEX, 8 is the cutoff).
- 8 to 11: B
Hematocrit (Hct)
- Range: 36 to 54
- Less likely to be tested than hemoglobin.
- Prioritization: B if high
- Assess for dehydration.
General Tip
- If a lab value is high and the nurse has no clue what is causing it, suspect dehydration.
Carbon Dioxide (CO2) - pCO2
- Range: 35 to 45 mmHg (millimeters of mercury)
- Prioritization: High CO2 is the focus
- In the 50s: C (Hypercarbia)
- Assess the respiratory system.
- Instruct the patient to do Pursed-Lip Breathing to prolong exhalation and remove excess CO2.
- In the 60s and higher: D (Respiratory Failure)
- Assess lungs, pursed-lip breathing
- Prepare to intubate and ventilate
- Call respiratory therapy
- Call the health care provider
- In the 50s: C (Hypercarbia)
Oxygen (O2) - Arterial Blood Gas (ABG)
- Range: 78 to 100
- Prioritization:
- Low, but in the 70s (70-77): C (Hypoxia)
- Assess the lungs.
- Administer oxygen.
- In the 60s or lower: D (Respiratory Failure)
- Assess the lungs.
- Administer oxygen.
- Prepare to intubate and ventilate.
- Call respiratory therapy.
- Call the healthcare provider
- Low, but in the 70s (70-77): C (Hypoxia)
Oxygen Saturation (O2 Sat) - Finger Probe (SaO2)
- Range: 93 to 100
- Prioritization: Below 93
- Hypoxia
- Assess the lungs.
- Administer oxygen.
- Hypoxia
Key Reminder for Respiratory Problems
- When dealing with respiratory issues, the order of assess and intervene can be flipped.
- In other words, you can administer oxygen first, then assess the patient's respiratory status.
- This applies to the CO2 and O2 levels.