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1. Question
The nurse reviews a client’s laboratory report and notes that the client’s serum phosphorus (phosphate) level is 1.8 mg/dL (0.58 mmol/L). Which condition most likely caused this serum phosphorus level?
Correct
Option A is the correct answer:
Rationale: The normal serum phosphorus (phosphate) level is 3.0 to 4.5 mg/dL (0.97 to 1.45 mmol/L). The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide– based or magnesium-based antacids. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia.
Test-Taking Strategy: Note the strategic words, most likely. Focus on the subject, a serum phosphorus level of 1.8 mg/dL (0.58 mmol/L). First, you must determine that the client is experiencing hypophosphatemia. From this point, think about the effects of phosphorus on the body and recall the causes of hypophosphatemia in order to answer correctly.
Incorrect
Option A is the correct answer:
Rationale: The normal serum phosphorus (phosphate) level is 3.0 to 4.5 mg/dL (0.97 to 1.45 mmol/L). The client is experiencing hypophosphatemia. Causative factors relate to malnutrition or starvation and the use of aluminum hydroxide– based or magnesium-based antacids. Renal insufficiency, hypoparathyroidism, and tumor lysis syndrome are causative factors of hyperphosphatemia.
Test-Taking Strategy: Note the strategic words, most likely. Focus on the subject, a serum phosphorus level of 1.8 mg/dL (0.58 mmol/L). First, you must determine that the client is experiencing hypophosphatemia. From this point, think about the effects of phosphorus on the body and recall the causes of hypophosphatemia in order to answer correctly.
Hypophosphatemia
Description
Hypophosphatemia is a serum phosphorus (phosphate) level lower than 3.0 mg/dL (0.97 mmol/L).
A decrease in the serum phosphorus level is accompanied by an increase in the serum calcium level.
Causes
Insufficient phosphorus intake: Malnutrition and starvation
Increased phosphorus excretion
Hyperparathyroidism
Malignancy
Use of magnesium-based or aluminium hydroxide–based antacids
Intracellular shift
Hyperglycemia
Respiratory alkalosis
Assessment
Cardiovascular
Decreased contractility and cardiac output
Slowed peripheral pulses
Respiratory: Shallow respirations
Neuromuscular
Weakness
Decreased deep tendon reflexes
Decreased bone density that can cause fractures and alterations in bone shape
Rhabdomyolysis
Central nervous system
Irritability
Confusion
Seizures
Hematological
Decreased platelet aggregation and increased bleeding
