CLT Patient Assessment & Clinical Evaluation 2 — Questions and Answers
Question 1: A patient's chart shows a creatinine of 4.2 mg/dL and BUN of 68 mg/dL. Which clinical condition does this pattern most strongly suggest?
- Hepatic failure
- Chronic kidney disease (Correct answer)
- Hemolytic anemia
- Diabetic ketoacidosis
Correct answer: Chronic kidney disease
Elevated creatinine and BUN together indicate impaired renal filtration, consistent with chronic kidney disease.
Question 2: When reviewing a patient's CBC, you notice a left shift with toxic granulation in neutrophils. This finding is most associated with:
- Viral infection
- Severe bacterial sepsis (Correct answer)
- Iron deficiency anemia
- Chronic lymphocytic leukemia
Correct answer: Severe bacterial sepsis
Left shift with toxic granulation indicates release of immature neutrophils under extreme demand, characteristic of severe bacterial sepsis.
Question 3: A PT/INR result of 3.8 is reported for a patient on warfarin therapy for atrial fibrillation. The most appropriate clinical action is to:
- Increase warfarin dose
- Notify the ordering physician immediately (Correct answer)
- Report as normal for anticoagulation therapy
- Repeat the test in 24 hours without notifying
Correct answer: Notify the ordering physician immediately
An INR of 3.8 exceeds the therapeutic range (2.0–3.0) for atrial fibrillation and represents a critical value requiring immediate physician notification.
Question 4: Which laboratory finding would most likely be seen in a patient experiencing syndrome of inappropriate antidiuretic hormone (SIADH)?
- Hypernatremia with high urine osmolality
- Hyponatremia with high urine osmolality (Correct answer)
- Hypernatremia with low urine osmolality
- Hyperkalemia with low urine sodium
Correct answer: Hyponatremia with high urine osmolality
SIADH causes water retention diluting serum sodium (hyponatremia) while the urine remains inappropriately concentrated (high osmolality).
Question 5: A patient presents with jaundice, elevated direct bilirubin, and elevated alkaline phosphatase with near-normal ALT/AST. This pattern is most consistent with:
- Acute hepatocellular injury
- Cholestatic liver disease (Correct answer)
- Hemolytic anemia
- Gilbert syndrome
Correct answer: Cholestatic liver disease
Elevated direct bilirubin and alkaline phosphatase with minimal transaminase elevation points to biliary obstruction or cholestatic disease.
Question 6: Which electrolyte abnormality is most commonly associated with prolonged QT interval on ECG and increased risk of cardiac arrhythmia?
- Hypernatremia
- Hypocalcemia (Correct answer)
- Hyperkalemia
- Hypermagnesemia
Correct answer: Hypocalcemia
Hypocalcemia prolongs the QT interval by delaying cardiac repolarization, increasing arrhythmia risk.
Question 7: A newborn screen shows elevated phenylalanine levels on two separate specimens. The laboratory technologist should:
- Report as normal variation for newborns
- Flag as critical and notify the ordering provider (Correct answer)
- Request a urine sample before reporting
- Repeat only if symptomatic
Correct answer: Flag as critical and notify the ordering provider
Persistently elevated phenylalanine in a newborn may indicate phenylketonuria (PKU), a critical finding requiring immediate provider notification for early intervention.
CLT Patient Assessment & Clinical Evaluation 2
A patient's chart shows a creatinine of 4.2 mg/dL and BUN of 68 mg/dL.
Which clinical condition does this pattern most strongly suggest?