Analysis Level Questions

Analysis level questions require that you examine/analyze information, break information into parts, identify relationships in the data, and then make inferences or draw conclusions.

Try this analysis level question

Mr. Yen is in acute renal failure and has also been diagnosed with chronic CHF. His urine output has been 84 ml in 8 hours. Which of the following lab work would you expect to find on his admission lab work? Select all that apply:

a. K+ 2.8
b. pH of 7.38
c. HCO3 of 35
d. pH of 7.50
e. CO2 of 52
f. pH of 7.29

Still with us? Usually those 4 words bring fear into the hearts of all nursing students. "Select All That Apply". Keep in mind the best strategy is to make sure that you are very clear on what the question is asking - and take one answer at a time. The topic of the question is what what lab work would be expected for a patient in renal failure and chronic heart failure. So you ask yourself

a. Is a potassium of 2.8 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, patients in renal failure have an elevated potassium 2.8 is hypokalemia
Eliminate this answer

b. Is a pH of 7.38 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, normal pH is 7.35-7.45. Patients in renal failure are in metabolic acidosis, so the pH would be low or less than 7.35.
Eliminate this answer.

c. Is a HCO3 of 35 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, normal HCO3 is 22-26. Patients in renal failure are in metabolic acidosis, and the failing kidneys can't keep the HCO3 (bicarb) levels normal - so they should be lower than normal.
Eliminate this answer.

d. Is a pH of 7.50 what I would expect for a patient in renal failure and chronic renal failure? Answer - no, normal pH is 7.35-7.45. Patients in renal failure are in metabolic acidosis, so the pH would be low or less than 7.35.
Eliminate this answer.

e. Is a CO2 of what I would expect for a patient in renal failure and chronic heart failure? Answer - no, normal CO2 levels are 35-45. Patients in renal failure are in metabolic acidosis, so the body will try to compensate by "blowing off" CO2 (remember Kussmaul's respirations?) and you should see a lower CO2 level.
Eliminate this answer.

f. Is a pH of 7.29 what I would expect for a patient in renal failure and chronic heart failure? Answer - yes FINALLY ;0), normal pH is 7.35-7.45. Patients in renal failure are in metabolic acidosis, so the pH would be low or less than 7.35.
Select this answer.

WHEW! All that work for just one answer?

That can really happen - but just to be sure - do one final check by making sure that the one you selected is an appropriate answer to what the question was asking and you're on your way to mastering select all that apply and analysis level questions.