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.

Why are Nursing School Tests / Exams SO Hard?

Welcome back. In yesterday's post we looked at knowledge and comprehension level questions.

Knowledge level questions just require you to have basic knowledge in order to answer a question. Comprehension level questions require you to understand basic knowledge.

Today let's look at application level questions.


Application Level Questions
Require you to know several pieces of information in order to answer the question.

Mr. Stevenson has CHF and will be going home on Digoxin and Lasix. Which of the following assessments would require immediate follow-up by the nurse.

a. rhonchi bilaterally
b. Na of 138 milliEquivalents/liter
c. K of 3.0 milliEquivalents/liter
d. Digoxin 1.5 nanograms per milliliter

In order to answer this question - you need to know the following pieces of information: normal blood levels of sodium, potassium, and Digoxin and if bilateral rhonchi are normal.

• Normal Na is 135-145
• Normal K is 3.5-4.5
• Digoxin is 0.8-2.0
• Rhonchi bilateraly is not normal

You would want to follow up on the assessment that indicates the patient is in the most danger or risk of harm. Normal lab values do not indicate risk - so eliminate b. and d.

Now you are left with the two abnormal assessments a low potassium and rhonchi. Neither are what you'd want for a patient - however the question is about Digoxin, Lasix, and CHF. The low potassium is the correct answer because low potassium puts the patient at increased risk for Digoxin toxicity.

In an application level question - it is not enough to have basic knowledge or to understand that knowledge. You must be able to apply your understanding of knowledge in the context of the question in order to pick the correct answer.

Our next blog will explain the differences in analysis level questions.