Labs 1
NCLEX Review Audio 8
Labs
Level
A
B
C
D
Importance
Low priority; no need to take action
Low priority; monitor closely
High priority; must take action
Highest priority
Priority C or D
1. Hold/stop medication (if applicable)
2. Assess (focused assessment)
a. Assess before you do, unless delaying doing an action to assess puts your patient at
higher risk.
3. Prepare to give (administer antidote, medication, etc.)
4. Notify HCP
a. Do not leave the bedside of a Level D.
Lab
Range
Serum Creatinine
Best indicator of renal
function
0.6 – 1.2
BUN
8 – 25
INR
Coumadin therapy
2–3
Potassium
3.5 – 5.3
(HESI: 3.5 – 5.0)
pH
7.35 – 7.45
Bicarbonate
22 – 26
C02
35 – 45
Priority Level
Abnormal is a Level A
(unless going for a diagnostic test with dye; still
not high priority)
If elevated, assess for dehydration.
≥ 4 is a Level C
< 3.5 is a Level C
5.4 – 5.9 is a Level C
≥ 6 is a Level D
≥ 6.0 – 6.9 is a Level D
 Check vitals; “As the pH goes, so goes
my pt.”
 No longer give HC03 for acidosis. HCP
treats underlying cause.
Abnormal is a Level A
High but in the 50s are Level C
[not COPD patients]
 Nothing to hold, assess respiratory
status, prepare to teach pursed-lip
breathing (usually corrects, so may not
reach Notify).
60’s is a Level D
[not COPD patients]
 Respiratory failure; emergency
Labs 2


Oxygen (PO2)
From ABG, not pulse ox
78 – 100
12 – 18
Hemoglobin
(12 – 16 women)
(14 – 18 men)
Hematocrit
36 – 54
BNP
Brain Natriuretic Peptide
Best indicator of CHF
Sodium
WBC
Platelets
RBC
Pursed-lip breathing won’t correct
Prepare to intubate and ventilate,
notify RT and HCP
Low but 70-77 is a Level C
 Nothing to hold, assess respiratory,
prepare to give o2
 With hypoxia, HR increases first before
RR
 *In coronary care, the two most
common causes of episodic tachycardia
are hypoxia and dehydration.
Low in the 60’s is a Level D
 2 defining characteristics of respiratory
failure: both CO2 and O2 in the 60’s.
o Nothing to hold, (apply o2)
assess respiratory status,
prepare to intubate and
ventilate, call RT/HCP.
8 – 11 is a Level B
 Assess for anemia, malnutrition
< 8 is a Level C
 Nothing to hold, assess for bleeding,
prepare to administer blood, notify
HCP.
3x the hemoglobin
 12x3 = 36; 18x3 = 54
Elevated is Level B
 Assess for dehydration
Elevated is a Level B
< 100
135 – 145
WBC = 5,000 –
11,000
ANC = > 500
CD4 = > 200
150,000 –
400,000
4 – 6 million
If abnormal it is a Level B
 High - assess for dehydration
 Low - assess for fluid overload
If abnormal and change in LOC, it is a Level C
If abnormal/low is a Level C
 CD4 < 200 = AIDS
Neutropenic precautions
Platelet < 90,000 is a Level C
Platelet count < 40,000 is a Level D
If abnormal it is a Level B
Labs 3
Memorize the 5 D’s
1. pH in the 6’s
2. Potassium in the 6’s
3. CO2 in the 60’s
4. O2 in the 60’s
5. Platelet < 40,000
Recommend learning C’s but do not worry about the others [low priority]