Mr. P's surgery is postponed after seeing the blood report. Which of the following reports is abnormal?

SCTIMST Staff Nurse - 2015 (Set-B)

Medical & Surgical Nursing

Medium

Appeared in: SCTIMST Staff Nurse - 2015 (Set-B)

Explanation

A serum creatinine level of 3 mg/dL is significantly higher than the normal range for a male (approximately 0.6–1.2 mg/dL).
This elevated level indicates impaired kidney function (renal disease), which poses a high risk for perioperative complications.
Complications include acute kidney injury (AKI), fluid and electrolyte imbalances, and toxicity from anesthetic agents and other drugs that are cleared by the kidneys.
Due to these risks, elective surgeries are often postponed when a patient has a critically high creatinine level to allow for further investigation and management of the kidney issue.

Option A: A hemoglobin of 11.9 g/dL is only mildly below the normal range for an adult male (approx. 14-18 g/dL). While it indicates mild anemia, it is not typically a critical value that would necessitate postponing surgery unless the procedure is expected to involve major blood loss.
Option B: A serum sodium level of 140 mEq/L is well within the normal range of 136–145 mEq/L. This value indicates normal fluid and electrolyte balance and is not a cause for concern.
Option C: A platelet count of 210,000/mm³ is within the normal range of 150,000–400,000/mm³. This indicates that the patient's blood has a normal ability to clot, which is a favorable finding before surgery.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Interpretation of pre-operative laboratory results in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's primary responsibility includes reviewing pre-operative lab results, identifying any abnormalities, and promptly reporting critical values to the surgeon and anesthesiologist to ensure patient safety.
Failure to recognize and report a high creatinine level could lead to life-threatening complications, including post-operative acute kidney failure or drug toxicity.
What if? If the patient's creatinine was 1.5 mg/dL, it would be considered borderline high. The surgery might proceed, but the anesthesia team would be alerted to take extra precautions, such as avoiding nephrotoxic drugs and carefully managing hydration.

How to Approach the Question

First, analyze the question's context: a surgery was postponed due to an 'abnormal' blood report. This implies you are looking for a value that is significantly outside the normal range and poses a serious risk.
Next, systematically evaluate each lab value provided in the options.
Recall the standard normal range for each test: Hemoglobin, Serum Sodium, Platelets, and Serum Creatinine.
Compare the patient's value to the normal range. A sodium of 140 and platelets of 210,000 are clearly normal. A hemoglobin of 11.9 is only slightly low.
Identify the value that is most significantly abnormal. A creatinine of 3 mg/dL is more than double the upper limit of normal, indicating a serious underlying issue.
Conclude that the significantly elevated creatinine is the most likely reason for postponing the surgery due to the high risk of renal complications.

Concept Tested & Keywords

Concept Tested: Interpretation of pre-operative laboratory results
Stem keywords: surgery postponed, blood report, abnormal
Lead-in keywords: Which of the following
Clinical cues: Postponement of surgery implies a significant, risk-posing abnormality.

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E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 178-180

E6 Pathology-Vandana Puri & Kavita Gaur Textbook of Pathology and Genetics p. 406-408