Prepping for the NCLEX: Review Normal Lab Values

Prepping for the NCLEX: Review Normal Lab Values

The National Council Licensure Examination (NCLEX) is an entry-level exam that qualifies you to practice as a nurse. It requires you to think critically and apply your knowledge to make important decisions on patient care. Studying for and taking the NCLEX can seem like a daunting task, but it’s not impossible. To help you prepare, here are some normal lab values to familiarize yourself with, as well as four other key nursing concepts you’ll need to know.

Lab Values For the NCLEX

You will need to memorize several normal laboratory values to pass the NCLEX. Knowing the norms will help you quickly compare with patient values and thus make appropriate clinical judgments. Here are some common lab values you may see on the exam.

Arterial Blood Gases (ABGs)

  • pH: 7.35-7.45
  • pCO2: 35-45 mEq/L
  • HCO3: 24-26 mEq/L
  • pO2: 80-100%

Cardiac

  • Troponin: <0.01ng/mL
  • C-reactive Protein: ≤0.8mg/dL
  • CD40 Ligand: 1.51-5.35mg/L
  • Creatinine Kinase: 0-3mcg/L

Chemistry

  • Amylase: 56-90IU/L
  • Lipase: 0-110units/L
  • Total Bilirubin: 0-1mg/dL
  • Albumin: 3.5-5g/dL
  • Alfa-fetoprotein: <10ng/mL is the adult normal; >500 indicative of liver tumors
  • Ammonia: 15-110mg/dL
  • BUN: 10-20mg/dL
  • Serum Creatinine: 0.6-1.2mg/dL
  • Creatinine Clearance: Females = 80-125mL/min, Males = 90-139mL/min
  • GFR: 125mL/min
  • Fasting Blood Glucose: <100mg/dL
  • HbA1C: Normal = <5.7, Prediabetic = 5.7-6.4, Diabetic if 6.5 or higher on 2 separate tests

Chemistry Values

  • Glucose: 70-110mg/dL
  • Specific gravity: 1.010-1.030
  • BUN: 7-22mg/dL
  • Serum Creatinine: 0.6-1.35mg/dL (< 2 in older adults)
  • LDH: 100-190U/L
  • CPK: 21-232 U/L
  • Uric Acid: 3.5-7.5mg/dL
  • Triglyceride: 40-50 mg/dL
  • Totalcholesterol: 130-200mg/dL
  • Bilirubin: <1.0mg/dL
  • Protein: 6.2-8.1g/dL
  • Albumin: 3.4-5.0g/dL

Hematology

  • HCT Female: 37-47%
  • HCT Male: 42-52%
  • HGB Female: 12-16g/dL
  • HGB Male: 14-18g/dL
  • WBC: 5,000-10,000/uL
  • Platelets: 150,000-400,000mm3
  • PT: 11-12.5 Seconds (1.5-2.5 times this if on warfarin)
  • aPTT: 30-40 Seconds (1.5-2 times this with heparin)
  • INR: 0.8-1.1 (if on warfarin 2-3)

Hematology Values

  • RBC: 4.5-5.0million
  • WBC: 5,000-10,000
  • Platelets: 200,000-400,000
  • Hemoglobin: 12-16g/dL for women; 14-18g/dL for Men
  • Hematocrit: 37-48% for Women; 45-52% for Men

Lipoproteins and Triglycerides

  • Total: <200mg/dL
  • Triglycerides: <150mg/dL
  • HDL: >60mg/dL
  • LDL: <70mg/dL
  • AST: <40U/L
  • ALT: <40U/L
  • ALP: 42-128U/L

Serum Electrolytes

  • Calcium: 8.5-10.9mg/L
  • Chloride: 98-107
  • Magnesium: 1.6-2.6 mg/dL
  • Phosphorus: 2.5-4.5mg/dL
  • Potassium: 3.5-5.1
  • Sodium: 135-145 mEq/L

Thyroid Function

  • Total T3: 70-205ng/dL
  • T4: 4-12mcg/dL
  • TSH: 0.4-0.6microunits/mL

Urinalysis

  • Urine Specific Gravity: 1.003-1.030
  • Volume: 1-2L/day
  • pH: 4.5-8
  • Glucose: <130mg/dL
  • RBC: ≤3RBCs
  • WBCs: ≤2-5WBCs/hpf
  • Protein: ≤150mg/dL
  • Bacteria: none
  • Ketones: none
  • Nitrites: negative

The ABCs of Nursing

The ABCs refer to three basic life-saving principles to prioritize in patient care. They are as follows:

  • Airway: The airway is always the top priority. If the airway is blocked, air cannot enter the patient’s body, and they will not be able to breathe. Ensure the airway is clear before taking any further steps.
  • Breathing: When the airway is clear, prioritize the patient’s breathing. Difficulty or lack of breathing is a life-threatening health hazard that must be addressed immediately. Additionally, if oxygen cannot reach the lungs, it cannot be circulated throughout the bloodstream.
  • Circulation: Once breathing has been stabilized, ensure the blood is circulating properly through the patient’s body. Without proper circulation, the patient is at significant risk of cardiac arrest or hypoxia.

Maslow’s Hierarchy of Needs

This hierarchy refers to the five basic needs required for physical and emotional health, typically visualized as a pyramid, with the most basic needs at the bottom and “higher-level” needs at the top. The top needs cannot be met without first meeting the bottom needs.

Maslow’s five needs in order of bottom to top are:

  • Physiological needs: These are the basic requirements for a human life. Physiological needs include food and water, air, shelter, sleep, and stability. If these needs are not met, a person is likely to be unhappy, as well as struggle to meet the higher needs on the hierarchy.
  • Safety needs: Physiological needs must be met before a person can feel safe. In addition to having physical safety, a person must also feel emotionally or psychologically safe (e.g., in relationships or in their environment). Some threats to safety include economic insecurity, physical illness or dangers, and toxic or abusive relationships.
  • Love/social belonging needs: Humans are social creatures, and thus need to feel a sense of love and belonging from others. Familial, platonic, and/or romantic relationships can fulfill these social belonging needs.
  • Self-esteem needs: Esteem can stem from both internal sources (e.g., the person’s own concept and opinion of themselves) and external sources (e.g., others’ words and actions). Having self-esteem means a person has respect for themselves and feels both independent and competent. Receiving recognition, praise, and appreciation from others can also boost self-esteem.
  • Self-actualization needs: Once the need for self-esteem is met, a person can strive for the highest point of the hierarchy: self-actualization. This refers to a person realizing and working toward their fullest potential, as well as understanding their own abilities and qualities. Self-actualization is a highly personal need and will look different for each individual.

Using Maslow’s hierarchy of needs can help you assess behaviors, prioritize outcome criteria, and plan interventions with the patient’s physical and emotional health in mind.

The Nursing Process

The nursing process outlines the sequence of steps needed to provide individualized patient care. The five steps of the process are:

  • Assessing: Assessing refers to checking the patient and collecting data.
  • Diagnosing: Diagnosing is using the patient’s data to identify the problem.
  • Outcome/Planning: In outcome/planning, you determine how to treat the problem.
  • Implementing: Implementing is putting your plan into action.
  • Evaluating: When evaluating, you determine whether the plan worked, and develop next steps accordingly.

The Six Rights of Medication Administration

All medical errors and oversights can be attributed to an inconsistency in following these six rights:

  • Right client: A nurse must identify a patient by checking the name on the ID band against the medical administration form, then asking that patient to state their name.
  • Right medication: To ensure a patient receives the right medication, a nurse should check the patient’s medication against the medication order and label. A nurse should only administer medications they prepare and verify.
  • Right dose: Precautions such as the unit dose system are used to ensure a patient receives the right dose. When performing medication conversions or calculations, having a colleague check your measurements can reduce dosage errors.
  • Right time: If medication is ordered for a specific time of day, a nurse should understand why – as well as when that timetable can and cannot be adjusted.
  • Right route: A prescriber must specify how medication should be administered (orally or via injection or IV), and a nurse must also double-check that information.
  • Right documentation: Documentation should be thorough and include all information listed in these six rights.

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