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Lab Values

How to Learn and Memorize Lab Values to Easily


Pass the NCLEX test
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Table of Contents
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INTRODUCTION

LEARN MEDICAL TERMINOLOGY THE CORRECT WAY

LEARN ROOT WORDS

BASIC CHEMISTRY PANEL

COMPONENTS OF BLOOD AND OBTAINING SAMPLES

OBTAINING SAMPLES

ELECTROLYTES

GASTROINTESTINAL TESTS

COAGULATION TESTS (WITH D-DIMER TESTS)

GLUCOSE TEST

INSULIN TYPES VALUES

ERYTHROCYTES AND SERUM ENZYMES

ERYTHROCYTE TESTS

SERUM ENZYMES

CARDIAC MARKERS

CARDIAC LAB VALUES

HEPATITIS AND HIV

NORMAL URINE TESTS

THERAPEUTIC MEDICATION LEVELS

LIPID LAB VALUES

PROTEIN LAB VALUES

RENAL FUNCTION TESTS, THYROID AND BLOOD TESTS

RENAL FUNCTION TESTS

THYROID TESTS
WHITE BLOOD CELL COUNT

EXERCISES

EXERCISES (ANSWERS IN BACK)

CONCLUSION

ANSWERS
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INTRODUCTION
This book is a guide to help NCLEX test aspirants and gives complete details of
medical terminology and lab values. People in the medical profession need complete
fluency in medical terminology, as lab values become the first step to understanding
the status of a patient. Medical professionals need to know and understand lab
values and practically apply them in order to make a diagnosis or track the status of a
patient.

This book is a complete analysis of everything one needs to pass the NCLEX test.
Youll find how to split the entire medical course into easy to understand segments.
Become a complete medical professional the easy way!

In a hurry to get started? Begin now to see how easy it can be.
Learn Medical Terminology the Correct Way

Important methods for studying and the basic things related to lab values form the
first step of your NCLEX test preparation.

Learn the medical terminology

All words (with an exception of a few) in medicine can be broken into the root word
and the added prefix or suffix. When the word is added to the beginning it becomes
the prefix and when the addition takes place at the end of the root word it becomes
the suffix.

Actual word Prefix + Root word


Example: supra + renal = suprarenal
Ab + duction = abduction

Root word + Suffix Actual word


Example: Cardi + ologist = cardiologist
Esophagi + eal =esophageal

Prefix + Root word + Suffix Actual word


Example: hypo + therm + ia = hypothermia
Medi + otars + al = mediotarsal

Learn Root Words

In medical terminology, there are four types of word parts: the basic word or root
word, the suffix, the prefix, and the qualifier. The root word refers to a medical
condition or practice. It may tell about procedures and what is used to diagnose or
treat the condition. The qualifier will tell the position, the size or quality and nature
of the disease or person. The suffix and prefix add information to the root word.
Body parts

Terminology Means Example


hist tissue histology, histogram
cardi heart cardiology, cardiologist
osteo bone osteoporosis
hemat blood hematuria
crani skull cranial
ren kidney renal
vagin vagina transvaginal
adeno gland adenitis, adenoids
angio blood vessel angioplasty, angiogenesis
arteri(o) artery arterial, arteriosclerosis
arthr(o) joint arthrotomy, arthalgia
ase enzyme lactase, amylase
cerebr(o) brain cerebrospinal
cervic(o) neck cervicitis
chol(e) bile, gall cholecystogram
cephal(o) head cephalalgia
chondr(o) cartilage chondroctomy
Prefixes

Terminology Means Example


infra below infracardiac
tri three trimester
hyper more hypertension, hypertonic
hypo less, under hypocalcemia
quadri four, square quadriplegic
multi, poly many multiple sclerosis, polycystic
retro backward retroverted uterus
circum surround circumference
ecto outside, outward ectopic pregnancy
uria urine pyuria, polyuria, albuminuria
extra outside extrahepatic
trophy growth hypertrophy, dystrophy
plasia development hyperplasia, neoplasia
a, an without anesthesia
epi above epiglottis
dipl, bi double diplopia
mono, uni single monocyte
derm(o), dermat(o) skin dermatologist, dermatitis
endo, intra in, within endoscope, endocrine
eu good, normal eupepsia, euphoria
eso inward esophagus
al, ar, ous, ior, ic pertains to dental, odorous, allergic
scler(o) hard atherosclerosis
brady slow bradycardia
dia through, across diameter
proct(o) anus, rectum proctoscopy, proctology
dys pain, difficult, bad dysplasia, dyspenia
aer(o) air, oxygen with air, gas aerobic, aerosol
ante before, forward anteversion, anteflexion
anti against antipyretic, antihistamine
cyte cell microcyte, leukocyte
macro large macrocyte
mening(o) meninges meningitis, meningeal
trans through, across transfusion, transurethral
hemi, semi half hemisphere, hemiplegia

Procedures

Terminology Means Example


centesis surgical puncture amniocentesis, paracentesis
pexy fix hysteropexy
break, surgical
clasis osteoclasis
fracture
tomy cut off deudenotomy
ectomy removal thrombectomy
scopy examine endoscopy
Conditions

Terminology Means Example


itis inflammation polyarthritis, laryngitis
iasis abnormal condition giardiasis, amebiasis
phag(o) eat, swallow dysphagia
plegia paralysis paraplegia
natal birth prenatal, postnatal
genic forms, origin nephrogenic, pyogenic
emia blood condition anemia, leukemia
pnea breath apnea, orthopnea
lysis breakdown thrombolysis, histolysis
pepsia digestion dyspepsia
megalo enlargement megalocyte
penia decrease oesinopenia
rrhea excessive diarrhea, rhinorrhea

Suffixes

Terminology Means Example


ology study of pathology
algia pain neuralgia, fibromyalgia
ate, ize use, subject to cauterize, saturate
graph instrument to record cardiograph
graphy process of recording tomography
ent, ist, er people involved in neurologist,
ism theory atheism
phobia fear hydrophobia
Basic Chemistry Panel
This group of tests involves collecting blood from a vein. Among the various
chemistry panels are:

Basic Metabolic Panel (BMP): This BMP has 8 tests, every one of them included
in the CMP. This gives the state of the respiratory system, kidneys, and blood
glucose. Youll learn the acid-base and electrolyte balance with this test.

Liver Panel: This has another name, the Hepatic Function Panel, and is used to
monitor disease, damage, and inflammation of the liver.

Comprehensive Metabolic Panel (CMP): The CMP is a set of 14 tests that


includes the BMP and information on blood proteins and liver.

Renal Panel: This helps track the function of the kidneys. Tests include eGFR,
BUN, creatinine and albumin for kidney function.

Electrolyte Panel: This will determine the fluid and electrolyte balance in the
body.

Thyroid Function Panel: Detect thyroid disorders with this test.

Lipid Profile: This helps to assess the risk of the person developing cardiovascular
disease.
Components of Blood and Obtaining Samples

Method to Get Blood Samples

Way to Take Lab Values


The healthcare provider uses lab values to diagnose, assess what a patient needs and
how much medication will be useful. The lab values measure the biochemistry taking
place within the patient. A technician must be proficient in drawing blood for lab
work; the procedure is simple.

Identify the patient. Ask the patient to give their name and his or her date of birth.
Gather the tubes and equipment. Wash your hands.

Obtaining Samples
Lab samples are taken from urine or from blood. At times, blood may be needed
from the peripheral artery, such as when you want exact values for arterial oxygen.
You can use any of the following to obtain a blood sample.

Needle: Direct needle, butterfly for small veins and vacutainer needles. When the
vein is small, youll want to use vacutainer needles with a butterfly
.
Finger stick: Choose the middle or ring finger for this procedure. Use the center of
the finger, as this will have softer tissue. Massage the finger and use a sterile lancet to
puncture the finger. Do not use the first drop as it contains tissue fluid. Give a gentle
press with the finger both before and during the procedure. Use the collection device
or tube, but do not milk the finger. Press a gauze pad over the puncture site until the
blood flow stops. Label the tubes. Dispose of waste material.

Heel stick: This is recommended for newborn babies. Heat the heel for three
minutes. Use a sterile lancet to puncture the side of the heel. Wipe the first drop of
blood away and collect the rest in the collection micro container. Raise the heel and
apply gentle pressure with gauze until the blood flow stops. Label the sample and
dispose of the waste.
Arterial blood stick: First, select an artery in the wrist, inside of the groin or
elbow. Clean with antiseptic and insert the needle. Apply pressure on puncture site
to stop blood flow. Hold pressure for at least 5 minutes.

Method for taking lab sample venipuncture procedure

Tie a rubber tourniquet 3-4 inches above the site where you will draw blood. Swab
the vein with alcohol. Use a butterfly or vacutainer needle to draw blood; keep the
bevel side up when you insert the needle. Ask the patient to make a fist. The needle
must enter the skin at a 15 - 30 angle. Draw the blood and withdraw the needle
with a quick backward motion.

Use of a vascular heel stick

You use the vascular heel stick to get blood samples from infants. You use this stick
for hemoglobin A1C or blood glucose.
Electrolytes

Electrolytes are anions and cations. Doctors test sodium, chloride, potassium and
bicarbonate most of the time. Here we list the electrolytes and their lab values.

Electrolyte Body functions Lab value


Calcium Fat transfer, transmit nerve impulse, bone building, blood Calcium, ionized: 4.4 - 5.1
clotting, muscle contraction, heart functioning mg/dL
Calcium, serum: 8.4 - 10.2
mEq/dl
Calcium, urine: 100 - 300
mg/24 h

Carbonate Related to breathing and metabolism, shows acidosis and Normal Range: 22-32 mEq/
alkalinity L
Optimal Reading: 27
Children Normal Range -
20 - 28
Optimal Reading: 24

Chloride Gives indication when excess water crosses cell membranes Chloride, CSF: 118-132
(CSF = Cerebrospinal Fluid) mEq/L
Chloride, serum: 98-108
mEq/L
Chloride, sweat: 0-35
mmol/L
Chloride, urine: varies with
diet
Potassium Related to heart function, major cation inside cells Potassium serum: 3.5 5
mEq/L
Potassium urine: varies
with diet

Sodium Most abundant cation in blood, maintains acid-base Sodium, serum: 135-145
balance, osmotic pressure transmits nerve impulses mEq/L
Sodium, urine: 135-145
mEq/L

Phosphorus Balances calcium Phosphorus serum: 3 4.5


mg/dL

Anion Gap Lower values show acidosis Normal: 7 16 mEq/L

Ratio of Sodium - Adult Normal Range: 26 -


to Potassium 38 (calculated)
Optimal Reading: 32
Ratio of - Adult Normal Range: 2.3 -
Calcium to 3.3 (calculated)
Phosphorus Optimal Reading: 2.8
Children Normal range: 1.3
- 3.3 (calculated)
Optimal Reading: 2.3

Notes:
1 Sodium is most abundant cation in the blood; maintains acid/base balance, osmotic
pressure, transmits nerve impulses. Low values lead to neurological problems and seizures.
2 Potassium is the major intercellular cation. When the value is too low, youll often find
cardiac arrhythmias.
3 High levels show acidosis with water crossing the cell membranes. Decreased levels with
low serum albumin show low water crossing the cell membranes.
4 Carbon dioxide plays a role in the respiratory system and body buffering system. Taken
with other electrolytes, it indicates acidosis and alkalinity.
5 Calcium takes part in bone metabolism, cardiac function, blood clotting, nerve impulse
transmission, muscle contraction and fat transfer. This is regulated by the parathyroid.
6 Phosphorus has a reverse role with Calcium.
7 Anion Gap is the mix of Sodium + Potassium CO2 + Chloride. Increased value shows
metabolic acidosis with more acids in a state of alkalinity taking place. Decreased levels show
alkalosis with more alkali metabolized in a state of acidosis.

Other electrolytes lab values are given in the list below.

Ammonia: 15-50 mol/L


Ceruloplasmin: 15-60 mg/dL
Copper: 70-150 g/dL
Creatinine: 0.8-1.3 mg/dL
Blood urea nitrogen: 8-21 mg/dL
Ferritin: 12-300 ng/mL (men), 12-150 ng/mL (women)
Glucose: 65-110 mg/dL
Inorganic phosphorous: 1-1.5 mmol/L
Ionized calcium: 1.03-1.23 mmol/L
Magnesium: 1.5-2 mEq/L
Phosphate: 0.8-1.5 mmol/L
Pyruvate: 300-900 g/dL
Total iron-binding capacity: 45-85 mol/L
Total serum iron: 65-180 g/dL (men), 30-170 g/dL (women)
Transferrin: 200-350 mg/dL
Urea: 1.2-3 mmol/L
Uric acid: 0.18-0.48 mmol/L
Zinc: 70-100 mol/L
Gastrointestinal Tests
a) Tests for steatorrhea: This measures the absorption of dietary fat. When
fat is not absorbed, it is often the result of intestinal disease, pancreatic
insufficiency or bile duct obstruction.
i. Indirect indications:
1. Reduced vitamin D absorption results in osteomalacia
2. Decreased serum levels show lower carotene absorption
3. Low vitamin K absorption can result in hemorrhage
ii. Quantitative determination of 72-hour stool specimen
1. normal < 5g per day
2. Equivocal 5 -7 g
3. Steatorrhea > 7g
iii.Examination through a microscope of fat-stained stool smears
iv. Measure of absorption of 125I oleic acid and 131I triolein
The pill containing both is administered orally. After 4 hours a
blood specimen is tested.
a. There is impaired pancreatic function when
absorption of oleic acid is normal while triolein
uptake is abnormal.
b. Failure of absorption of both shows the
malabsorption of the fat is not related to the
pancreas.

b) Detection of blood in the stool: Varies causes of blood in the stool include
carcinoma, hemorrhoids, Crohns disease or an ulcer in the GI tract. When it
occurs in the upper GI tract, often the blood appears dark or black and when
the bleeding is in the lower GI region, the blood is often red.

c) Hollander test: A Hollander test is preformed after surgical treatment for a


peptic ulcer. The acid in the gastric fluid is measured before and after insulin
is administered to induce hypoglycemia. MAO over BOA increase will stay less
than 2 mEq/hr.
d) Disaccharidase deficiencies: This deficiency is more common in babies
and is related to colic. Lactase and sucrase deficiencies are more common
compared to isomaltase deficiency.

e) D-Xylose test: This test is used to check monosaccharide absorption. Test is


performed following the oral administration of the monosaccharide solution.

f) The Schilling test: This test is used to check the malabsorption of vitamin
B12.
Coagulation Tests (With D-Dimer Tests)
Coagulation tests tell us how fast the blood clots. D-Dimer tests rule out deep vein
thrombosis (DVT) and Pulmonary embolism (PE). The coagulation study includes
Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and International
Normalized Ratio (INR). Normal lab values for these tests are:
PT: 10 12 seconds
PTT: 30 45 seconds
INR: 1 2
D-Dimer: High negative values such as 500 ng/ml excludes VTE (Venous
thromboembolism)
Glucose Test
Glucose levels that are not managed properly can cause damage to blood vessels,
nerves, kidneys, and eyes.

FBS: Fasting blood sugar test is done to check for diabetes and pre-diabetes. This
test is performed 8 hours after the person has eaten.

The 2-hour post-prandial blood sugar: This tests whether a person is taking the
correct amount of insulin. It is performed 2 hours after eating.

Random blood sugar: Blood sugar levels are tested without a fixed time frame.

One-step and two-step glucose tolerance test: The OGTT (One-step glucose
tolerance test) is performed after the fasting blood sugar test. The patient drinks 50g
of glucose. The blood is tested after one hour. If the result is positive, then a repeat
test is performed after 2 hours.
Oral glucose tolerance test: This is a diagnostic test for diabetes and pre-
diabetes. Can be used to diagnose diabetes in pregnant women between the 24th and
28th week of pregnancy. The test is performed after the patient drinks a sweet drink
with glucose.

Hemoglobin A1c: Tests how much glucose will stick to red blood cells. This is a
diagnostic test for diabetes.
Insulin Types Values
You have 4 types of insulin.

Rapid-acting: This lasts for 5 hours, though it takes 50 100 minutes to peak. It
takes approximately 15 minutes for the insulin to reach the blood.

Short-acting: This insulin remains in the blood for 4 8 hours. It will peak in 3 5
hours though it reaches the blood in 30 minutes.

Intermediate-acting: Lasts for 14 20 hours and peak 6 18 hours from the time
taken. The insulin reaches the blood in 2 6 hours.

Long-acting: This stays in the blood for 20 24 hours. The peak is small and
occurs 10 16 hours from the time it is injected. Time taken to reach the blood is 6
13 hours.
Erythrocytes and Serum Enzymes

Erythrocyte Tests
Erythrocyte Sedimentation Rate or sed rate shows how much inflammation is
present in the body. This test measures the speed at which RBC fall to the bottom of
a test tube.
The doctor orders a sed rate test when the patient shows one or more of the following
symptoms:
Muscle contractions
Unexplained fevers
Unexplained vague symptoms
Certain types of arthritis

The normal range of results by the Westergren method is given:


Adults
Men aged less than 50 years: lower than 15 mm/hr.
Men older than 50 years of age: lower than 20 mm/hr.
Women aged less than 50 years: lower than 20 mm/hr.
Women older than 50 years: lower than 30 mm/hr.
Children
Newborn: 0 2 mm/hr.
Newborn to puberty: 3 13 mm/hr.

This test can use be used to track:


a) Bone infections
b) Inflammatory diseases
c) Autoimmune disorders
d) Some types of arthritis
e) Tissue death

Abnormal results
Though the result is indicative, it is not conclusive regarding diagnosis. One has to
confirm the diagnosis through other tests. Medical conditions linked to abnormal
results include:
Kidney disease
Anemia
Pregnancy
Cancers
Thyroid disease
Our immune system protects our body from attack by pathogens. An autoimmune
disorder is when the immune system mistakes the normal body cells for intruders
and destroys the healthy cells. People with autoimmune disorders have a higher
incidence of increased ESR or sed rate. Common examples include Lupus and
Rheumatoid arthritis. When the level of ESR is high and the incidence of
autoimmune disorder is lower, it may indicate the following conditions:
Primary Macroglobulinemia
Allergic vasculitis
Hyperfibrinogenemia
Polymyalgia rheumatica
Giant cell arteritis
Necrotizing vasculitis

Abnormalities in the ESR rates could arise from other conditions. Increased rates
may occur due to bone infections, Rheumatic fever, tuberculosis, systemic infection,
heart or heart valve infections and severe skin infections. Lower rates can occur in
the presence of hyperviscosity, congestive heart failure, sickle cell anemia, or
leukemia.

Serum Enzymes
Abnormal serum activity and enzyme levels show disease or dysfunction of an organ.
An elevated SGOT level indicates damage to the liver, but it can occur due to
mononucleosis, muscle damage, infection or viral disease. Normal SGOT levels for
adults are between 0 and 35 units per liter. The SGOT level helps monitor the work
of the liver, kidney, heart, red blood cells, muscles, and pancreas.

Muscular dystrophy: Pateints with muscular dystrophy often show abnormal


elevations in these:
a) lactic dehydrogenase
b) aldolase
c) phosphohexose isomerase
d) glutamic-oxalacetic transaminase

This kind of elevation of the enzyme activity is common in those with acute cerebral
vascular accidents, but not found in other neurological disorders.

Myocardial infarction: During a myocardial infarction and pulmonary embolism,


the injured tissue causes the increased activity of the related enzymes. In a typical
situation, the serum CPK activity goes over the normal range within 6 or 7 hours and
within 24 hours reaches the peak, often within 2-10 times the normal range. It takes
3 to 4 days to subside to normal levels. The serum LDH activity exceeds normal
activity within 24 to 48 hours, peaking within 3 to 6 days. The serum SGOT (serum
glutamic oxaloacetic transaminase) is released into the blood stream when the liver
or the heart is damaged. SGOT has another name aspartate aminotransferase (AST).
Serum glutamic pyruvic transaminase (SGPT) also helps in determining abnormal
states. During a myocardial infarction, the normal cardiac markers become elevated:
creatine, myoglobin, kinase spikes during the first 24 hours, but then drop fast.
Troponin I and Troponin T spike over the first day and remain elevated for 6 or 7
days.

The normal levels of SGOT are 5 - 43 units per liter, while the level of SGPT is 7 - 60
units per liter. Females have a lower upper limit.
ADULT CHILDREN
HEPATIC
NORMAL RANGE OPTIMAL READING NORMAL OPTIMAL
ENZYMES
MALE FEMALE MALE FEMALE RANGE READING

AST (Serum
Glutamic-
Oxalacetic 0 42 U/L 21 - -
Transaminase -
SGOT )1

ALT (Serum
Glutamic-Pyruvic
0 48 U/L 24 - -
Transaminase -
SGPT)2

ALKALINE
20 125 U/L 72.5 40 400 U/L 220
PHOSPHATASE3

GGT (Gamma-
Glutamyl 0 45 U/L 22.5 0 65 U/L 32.5 - -
Transpeptidase)4

LDH (Lactic Acid


0 250 U/L 125 - -
Dehydrogenase)5

BILIRUBIN,
0 1.3 mg/dl 0.65 - -
TOTAL

Notes:
1 You see AST in muscles, pancreas, kidney, heart and liver. It is released when heart or
liver tissue damage occur.
2 Congested liver shows low level or AST and high levels of cholesterol. High AST levels can
also point to alcoholism, myocardial infarction, chemical pollutants, kidney infection, liver
damage, or mononucleosis.
3 Tumor marker presents in bone injury, skeletal growth, and pregnancy. Low levels show
protein deficiency, vitamin deficiencies, malnutrition, and hypoadrenia.
4 We see high levels of GGT in bile duct obstruction, cases of excessive magnesium
consumption, cholangitis, alcoholism, drug abuse and liver disease. Low levels are found in
hypothalamic malfunction, low magnesium levels, and hyperthyroidism.
5 - Higher levels found when there is cell death or leakage from the cell, and sometimes used
along with other tests to find the presence of myocardial and pulmonary infarction. Decreased
levels are indicative is hypoglycemia, low organ or tissue activity, adrenal exhaustion, and
malnutrition.
6 High levels of Bilirubin indicate hemolytic anemia, low sun exposure, the toxicity of
certain drugs, mononucleosis and liver disease. Decreased levels indicate excessive fat
digestion, nitrogen deficient diet, and inefficient liver function.

Cardiac Markers
During a myocardial infarction, many cardiac markers are elevated:
Myoglobin
Creatine
Kinase
Troponin I
Troponin T

Cardiac Lab Values


1. Creatine Phosphokinase (CK): Increases after an acute myocardial
infarction. It reaches a peak 16 30 hours later and returns to normal in
approx. 4 days. 25 200 U/L; 32 150 U/L.

2. CK-MB CK isoenzyme: Increases 6-10 hours after an acute myocardial


infarct. The peak is at 24 hours; remains elevated for 72 hours.
< 12 IU/L if total CK is < 400IU/L; <3.5% of total CK if total CK > 400 IU/L.

3. Lactate dehydrogenase (LDH) Total LDH level rises 2 5 days after an


MI. This elevated level lasts for 10 days. 140 280 U/L.

4. LDH-1 and LDH-2 LDH isoenzymes: In normal cases, the level of LDH-1
is less than LDH-2. After an acute MI, the level of LDH-2 does not change but
the level of LDH-1 rises. This condition is called a flipped condition. This
flipped pattern appears 12-24 hours after an MI and remains so for 48 hours.
LDH-1 18% - 33% LDH-2 28% - 40%.

5. SGOT: Spikes in 8 -12 hours and the peak will happen in 18 -30 hours. 10
42 U/L.

6. Myoglobin: This helps to accurately diagnosis an MI. The heme protein


becomes abnormal within 1-2 hours of an MI with a peak in 4 -8 hours. Drops
to normal in 12 hours. < 1.

7. Troponin Complex: Peaks within 10 24 hours and drops within 1 2


weeks. < 0.4.
Myocardial Infarction Markers

MI Serum Markers Detected Peak Fall


Myoglobin 13 18 12 18
CK/CK-MB 38 12 16 24 48
MB Isoforms 16 48 12 48
cTn I: 5 9 days
Troponin Complex 36 10 24
cTn T: 7 14 days
Hepatitis and HIV

People who test positive for HIV will require lab work. These laboratory tests will
include one or more of the following:

CD4/T-Cell count: CD4 cells show how the health of the immune system is and
one can get a good idea of the immunosuppression measure in the body.
The normal range of CD4 cells in a healthy body: 500 cells per cubic mm of blood.
A count lower than 200/mm3 is diagnosed as AIDS.
This test is important for healthcare providers as to the best way to treat the HIV
infection.

CD4 Percentage: Tests how many white blood cells are CD4 cells. For long-term
measurements, this CD4 percentage will give more accurate results though, for a few,
CD4 count will be the best way to determine the health of the person.

Viral Load (VL): With the Viral Load test, one can check how much of HIV is
present in the blood. HIV treatment is aimed at keeping the CD4 count high and the
Viral Load undetectable. This test will show how well the treatment for HIV is
proceeding.

Complete Blood Count (CBC): This measures the individual concentration of red
blood cells, white blood cells, and platelets in the blood.

Serum Chemistry Panel: Gives as indication of metabolism, including the health


of the liver and kidneys. This test reports blood sugar levels, calcium levels and so on.
It can be used to measure the impact of medication and whether or not adjustments
are needed.

Sexually Transmitted Disease (STD) screening: Diseases like gonorrhea,


chlamydia, and syphilis need to be checked.
PAP Smear Cervical and Anal: Smear to check conditions that could be
cancerous or become cancerous in the future. When women have HIV, they will have
abnormal cell growth on the cervix. Abnormal anal cells will occur for HIV-positive
men and women. If left untreated, these could become cancerous.

Hepatitis A, B, and C Tests: These tests will determine whether the person has
had or currently does have hepatitis. Through this test the healthcare provider will
know whether vaccines or medications are needed for hepatitis. When a person has
hepatitis, the medication for HIV might interfere with hepatitis. Or the medicines
taken for hepatitis might aggravate the HIV. Therefore, hepatitis needs to be ruled
out (or in) if a patient is HIV positive.

Tuberculosis (TB) skin test: Tests if a person has been exposed to TB and
whether further tests are needed. The test is not conclusive by itself. An early
screening will help prevent transmission of TB to others. The test does not diagnose
TB, but only tests whether or not a person has been exposed to TB. A positive test
warrants additional follow-up tests such as a chest x-ray.

Toxoplasmosis screening: Checks for a parasite that does severe damage to the
eye, brain, and other organs when the person has a weakened immune system. May
require preventive treatment. A person that is HIV positive may need another
screening if their CD4 count falls below 100.

Fasting Lipid Panel (Cholesterol and Triglycerides): Measure cholesterol


levels and fat proteins. Helps to determine the best course of treatment since the
metabolism of fats can effect the heart.

Fasting Glucose (Blood Sugar): Regular test for pre-diabetes and diabetes. Some
HIV medicines might affect blood sugar and complicate diabetes.
Normal Urine Tests

Urine tests are needed before surgery or for routine examinations. Includes tests to
to rule out the possibility of infections and abnormalities.

Color: Normal lab value for color is straw, pale or yellow. Dark pink or brown
means there is the presence of blood, while orange may occur due to medications or
kidney failure. Dark yellow points to dehydration.

Smell: Normal lab value for smell is nutty. A fruity smell shows uncontrolled
diabetes.

pH (potential hydrogen): Normal lab value for urine is 4.6 8.0. High levels of
pH can occur if the person has a urinary tract infection, asthma, a kidney disease or
has had severe vomiting. Low values occur in aspirin overdose, uncontrolled
diabetes, starvation or dehydration.

Glucose: Normal lab value in urine is 1 15 mg/dL. Increased glucose occurs if the
patient has diabetes, brain injury, liver damage, pregnancy, or some types of kidney
diseases.

Specific gravity: Normal lab value is 1.005 1.030. High levels occur due to
decreased fluid intake or loss of fluid due to vomiting or sweat. Low levels can
indicate kidney disease or too much fluid intake.

Protein: Normal lab value for this is none. The presence of protein can indicate
diabetes, high blood pressure, leukemia, poison, heart failure or an infection.

Ketones: Normal lab value for this is none. Starvation or diet-related disorders
could result in ketones. Ketones are also found in patients with uncontrolled
diabetes.
Microscopic analysis: In the normal lab value range we see no red blood cells or
white blood cells, cast, bacteria or yeast cells. Squamous cells or parasites are absent.
A few crystals may be present.

Volume: Normal lab value for volume is 800 2,500 mL in 24 hours.

Leukocytes: There should be no leukocytes (white blood cells). Abnormal presence


shows past or present infection.

Blood: This may be present if the patient has kidney stones, an infection, kidney
disease, or cancer. Normal lab value is none.

hCG: Pregnancy test. If the patient is a man, note on the chart by using the term NA
or Not Applicable.

Epithelial cells: This happens in a normal case when the collected urine sample is
contaminated. However, if contamination is ruled out, further tests are needed to
explain the presence of epithelial cells.

Bacteria: Presence of bacteria shows an infection.


Therapeutic Medication Levels

These tests check for the levels of medicine present in the blood. When the blood has
a certain level of a drug, it becomes effective to treat the medical condition. This type
of test is required for patients who take the following drugs:
Antibiotics like Gentamicin to treat infections
Phenytoin to treat seizures
Digoxin to treat abnormal heart beats

Here are the normal lab values for some drugs that people take.

Amikacin: 15 to 25 mcg/mL

Aminophylline: 10 to 20 mcg/mL

Amitriptyline: 120 to 150 ng/mL

Carbamazepine: 5 to 12 mcg/mL

Cyclosporine: 100 to 400 ng/mL (12 hours after dose)

Desipramine: 150 to 300 ng/mL

Digoxin: 0.8 to 2.0 ng/mL

Disopyramide: 2 to 5 mcg/mL

Ethosuximide: 40 to 100 mcg/mL

Flecainide: 0.2 to 1.0 mcg/mL

Gentamicin: 5 to 10 mcg/mL

Imipramine: 150 to 300 ng/mL

Kanamycin: 20 to 25 mcg/mL

Lithium: 0.8 to 1.2 mEq/L

Nortriptyline: 50 to 150 ng/mL


Phenobarbital: 10 to 30 mcg/mL

Phenytoin: 10 to 20 mcg/mL

Primidone: 5 to 12 mcg/mL

Procainamide: 4 to 10 mcg/mL

Quinidine: 2 to 5 mcg/mL

Salicylate: varies with dosage

Sirolimus: 4 to 20 ng/mL (12 hours after dose; varies with use)

Tacrolimus: 5 to 15 ng/mL (12 hours after dose)

Theophylline: 10 to 20 mcg/mL

Tobramycin: 5 to 10 mcg/mL

Note:

mcg/mL = microgram per milliliter

ng/mL = nanogram per milliliter

mEq/L = milliequivalents per liter

mcmol = micromole
Lipid lab values

NORMAL RANGE OPTIMAL READING


CHOLESTEROL 1 120 240 mg/dl 180

LOW DENSITY LIPOPROTEIN


62 130 mg/dl 81
(LDL) 2
HIGH DENSITY LIPOPROTEIN
35 135 mg/dl +85 mg/dl
(HDL) 3
TRIGLYCERIDES 4 0 200 mg/dl 100
CHOLESTEROL/LDL RATIO 16 3.5

Notes:
1 Two varieties of cholesterol are HDL and LDL. The HDL is preferred for good health. Elevated
cholesterol occurs during hypothyroidism, atherosclerosis, pregnancy and diabetes. Low levels are
seen during pregnancy, anemia, malignancies, liver insufficiency, malnutrition, and depression.
2 Studies show the correlation between high levels of LDL and arterial atherosclerosis.
3 High levels of HDL mean a healthy lifestyle unless one has liver disease.
4 High levels show the presence of hypothyroidism, myocardial infarction, nephrotic syndrome,
liver disease, metabolic disorders, atherosclerosis, pancreatitis, and toxemia.
Protein Lab Values

NORMAL RANGE OPTIMAL READING


PROTEIN
6 8.5 g/dl 7.25
TOTAL 1
ALBUMIN 2 3.2 5.0 g/dl 4.1
GLOBULIN 3 2.2 4.2 g/dl (calculated) 3.2
ALBUMIN/
GLOBULIN
0.8 2.0 (calculated) 1.9
RATIO (A/G
RATIO)
Values for adults only
1 Increased levels happen in liver disease, alcoholism, tuberculosis, lupus, chronic infections,
and leukemia. The decrease in the level occurs for malabsorption, poor nutrition, severe burns,
diarrhea and liver disease.
2 Albumin constitutes more than half of serum protein. High levels are seen when the person
has multiple myeloma, dehydration, shock, or sometimes liver disease. Low levels are seen in liver
disease, fever, poor diets, edemas, low amount of iron in the diet, infection, diarrhea,
hypocalcemia and third-degree burns.
3 The function of globulins varies among which is a carrier of antibodies (IgE, IgM, IgG, and
IgA), metals, lipids, and a few hormones.
Renal Function Tests, Thyroid and Blood Tests

Renal Function Tests

MALE FEMALE
NORMAL OPTIMAL NORMAL OPTIMAL
RANGE READING RANGE READING
B.U.N. (Blood Urea
7 25 mg/dl 16 7 25 mg/dl 16
Nitrogen) 1
CREATININE 2 0.7 1.4 mg/dl 1.05 0.7 1.4 mg/dl 1.05
URIC ACID 3 2.5 7.5 mg/dl 5.0 3.5 7.5 mg/dl 5.5
BUN/CREATININE 6 25 6 25
4
15.5 15.5
(calculated) (calculated)

Notes:
1 Increased levels of B.U.N. occur due to kidney damage, low fluid intake, exercise, high protein
intake, certain drugs, heart failure or intestinal bleeding. Low levels are seen when the person has a
low nitrogen diet, liver damage, malabsorption or poor diet.
2 Certain drugs that block kidney function might induce high levels of creatinine. This also happens
when the person has kidney disease or muscle degeneration. We see low levels when a woman is
pregnant, a person has protein starvation, kidney damage or liver disease.
3 Elevated level of uric acid indicate high protein diets, alcoholism, kidney disease, infections, gout,
and pregnancy (with toxemia). Low levels might be indicative of liver damage, malabsorption, or
kidney disease.
4 This value shows an accurate estimate of the kidney and liver functions.

Thyroid Tests

Thyroid lab values

OPTIMAL
NORMAL RANGE
READING
THYROXINE (T4) 1 4 12 ug/dl 8 ug/dl

T3 -UPTAKE 2 27 47 % 37%
FREE T4 INDEX (T7) 4 -12 8
THYROID-STIMULATING HORMONE
0.5 6 mill U/L -
(TSH) 3

Notes:
1 Increased levels seen in people with hepatitis, acute thyroiditis, and hyperthyroidism. Low levels
found in chronic thyroiditis, malnutrition, cirrhosis, hypothyroidism, and cretinism.
2 High levels found in severe liver disease, pulmonary insufficiency, hyperthyroidism and metastatic
malignancy. Low levels are present in normal pregnancy, hyperestrogenism status, and
hypothyroidism.
3 TSH is produced by the anterior pituitary gland. It stimulates the release of the stored thyroid
hormones. TSH release is elevated when T3 and T4 are low and low when T3 and T4 are high.

White Blood Cell Count

Lab Values for Blood

ADULT
CHILDREN
MALE FEMALE
Normal Optimal Normal Optimal Normal Optimal
range Reading range Reading range Reading
HEMATOCRIT
39 53 % 46 36 49 % 41 51 61 % 56
(HCT)

HEMOGLOBIN 12 17 g/ 13 16 g/ 15 21 g/
14 14 17
(HCB) dl dl dl
Mean
Corpuscular Higher range in
27 33 pg. 30 27 33 pg. 30
Hemoglobin newborns and infants
(MCH)

Mean
Higher range in
Corpuscular 90 99 fl 90 90 99 fl 90
newborns and infants
Volume (MCV)

Mean
Corpuscular
Higher range in
Hemoglobin 32 37 % 34 32 37 % 34
newborns and infants
Concentration
(MCHC)

Red Blood Count 4.2 5.6 3.8 5.2 Lower range in


4.9 4.55
(RBC) mill/mcl mill/mcl newborns and infants
White Blood 3.8 10.8 3.8 10.8 Higher range in
7.3 7.3
Count (WBC) thou/mcl thou/mcl newborns and infants
129 399 129 399 Higher range in
Platelet Count 267 267
thou/mcl thou/mcl newborns and infants
NEUTROPHILS
AND
47 72 % 60.7 47 72 % 60.7 30 60 % 45
NEUTROPHIL
COUNT1

LYMPHOCYTE
S and
18 49 % 33 18 49 % 33 25 50 % 37.5
LYMPHOCYTE
COUNT2
MONOCYTES
and MONCYTE 0 -9 % 4.5 0 -9 % 4.5 -
COUNT3

EOSINOPHILS
and
0 -5 % 2.5 0 -5 % 2.5 -
EOSINOPHIL
COUNT4

BASOPHIL and
BASOPHILIC 0 -2 % 1 0 -2 % 1 -
COUNT5

Notes:
1 neutrophils defend the body against infections and antigens higher value indicates infection
2 high values indicate infection such as chicken pox, measles, infectious mononucleosis, and
rubella
3 higher levels occur during chronic infections, tissue breakdown, lymphomas, leukemia
(monocytic), carcinomas
4 elevated levels show presence of parasites or allergic reactions
5 high may indicate allergic reaction; little is really known about basophilic activity except that
they carry serotonin, heparin, histamine
EXERCISES

Exercises (answers in back)


1. Which of the following would indicate anemia?
a. Male has RBC 6.2 million/mcL
b. Female has RBC 5.6 million/mcL
c. Male has 5.8 million/mcl RBC cells
d. Female has 5.8 million cells/mcL RBC

2. Cause of iron-deficiency anemia would be:


a. Not drinking milk daily
b. Does not include leafy vegetables of meat
c. Does not do exercises
d. Does not drink enough water with the food

3. Which of the following sexually transmitted diseases are not curable?


a. Gonorrhea
b. Syphilis
c. Hepatitis B
d. Chlamydia

4. In a patient who is 7 years old, which of the following cell counts of


CD4 indicates that he or she has HIV infection?
a. 650 cells per microliter of blood
b. 180 cells per microliter of blood
c. 400 cells per microliter of blood
d. 500 cells per microliter of blood

5. What percentage of blood can be help in the kidneys?


a. 11%
b. 16%
c. 22%
d. 30%
6. What is the role of HCO3?
a. The body does not need it
b. It buffers the blood so that the pH remains constant
c. Our body releases the carbonate as waste
d. Carbonate helps improve the nerve signaling

7. The normal range for Potassium for a healthy person is:


a. 0 10
b. 1.2 - 3.4
c. 2.7 4.8
d. 3.5 5.0

8. How many platelets should be there in a unit of blood?


a. 5,000 10,000
b. 50,000 200,000
c. 150,000 450,000
d. 200,000 300,000

9. What is the normal lab value for lymphocytes?


a. 500 600
b. 1000 4000
c. 2000 5000
d. 10,000 200,000

10. What is the normal range of chloride?


a. 15 30
b. 25 40
c. 60 85
d. 95 105
Conclusion

Hope you enjoyed reading and learning from this book. This gives you insight into
how to prepare the correct way. Most things happen to those who are prepared! Only
if you prepare well, will you succeed.

Wish you success on your NCLEX test!


Answers
1c
2b
3c
4b
5c
6b
7d
8c
9b
10 d