Walkthrough: Physiological Adaptation Q3 – NCLEX-RN®

00:01 The nurse is reviewing the laboratory results for a client and notes a blood urea nitrogen level of 31.

00:07 Which situation most likely contributes to this result? Okay. So let's break this down. I'm looking at lab work, and my client has a BUN level of 31.

00:19 Well, that's a number. So you're going to have to ask yourself, is that high, low, or normal? Then I'm going to say, which situation most likely contributes to this result? So put this question into your own words. And now, we're going to bring in the answer choices.

00:37 What I'm going to ask you to do is write down one, two, three, four on your piece of scratch paper or write on wipe off board, and I want you to work through the answers choices without us first.

00:47 Pick your answer, and then I'll walk you through it.

00:58 Welcome back. Okay. Let's take a look at this. We have a BUN, a blood urea nitrogen level of 31.

01:05 Now, a normal level is roughly 8 to 20.

01:09 And we know on the NCLEX and that starting in 2023 were able to have those values available to you.

01:16 But it's a good idea to always have a rough idea of what ranges are.

01:21 So eight to 20-ish is the normal level.

01:25 So this is high. So now, I have to be thinking about, what are the things that could cause an elevated BUN? Okay. So would a low protein diet cause an elevated BUN? Really, I remember something about protein and - oh, wait a minute.

01:43 BUN is blood urea nitrogen. Urea is a product of the metabolism or breakdown of protein.

01:51 So, I would not have a higher BUN with a low protein diet. So that's an easy one to eliminate.

01:58 Now, would a UTI, a urinary tract infection cause an elevated BUN? No. That's nothing to do with a UTI, right? They'd be looking for something, yeah, I'd be looking for other things.

02:12 White cells in their urine, so BUN is not an indicator of a UTI, an elevated BUN.

02:19 Now, it can be an indicator of dehydration. So keep that in mind.

02:25 If the patient has a UTI and they're dehydrated, but remember, it's just telling me UTI.

02:31 That's all the information I have, so I'm not going to assume that they're dehydrated.

02:36 Let's look at burn injuries. Okay. So is there a connection between burn injuries and a BUN? Let's say, for example, I'm not real sure.

02:47 So I'll come back to that one because I know there's a lot of fluid shifting that goes on, but I know I've eliminated one and two.

02:54 So three, I'm going to put on hold, because it seems kind of complicated.

02:58 Number four, fluid-volume overload.

03:02 Okay. When we say fluid-volume overload, we're likely referring to the intravascular space, my blood vessels, my veins, my arteries, right? So I'd have extra fluid onboard. I have more fluid in my intravascular space than is normal or what my body would like. So what happens to lab work when I have extra fluid-volume on board? Would a BUN level be higher or lower? Now, I know with sodium, when I have extra fluid intravascularly, it's Dilutional hyponatremia, right? So my sodium is lower. Yeah. I would not expect my BUN level to be higher.

03:42 If I'm fluid-volume overloaded, it's going to be lower, because it's going to be diluted.

03:48 So I'm going to eliminate number four. Now, I got to go back to number three.

03:52 I've eliminated one, two, and four, right? You're with me on that.

03:56 Now, we're left with number three. I'm not convinced that's the right answer.

04:01 Hey, listen. If you've done the work on one, two, and four, sometimes, the right answer, you're not going to be, like, 100% sold, but if you've done the work, you've ruled those out, you can feel as confident as possible in going with that remaining answer.

04:19 Now, let me explain to you why burn injuries truly is the correct answer.

04:23 Burns are massive trauma to tissue. Right? And it causes huge fluid-volume shifting.

04:31 Your fluid doesn't stay in your intravascular space. It is blowing up into all your tissues.

04:37 Think of the images that you've seen of burn victims.

04:40 When that fluid is leaking out significantly from your intravascular space, it's going into the tissues.

04:47 So what's left in your intravascular space is almost like the patient is incredibly dehydrated, right? Because a lot of the liquid, the fluid volume has moved into the tissues.

04:58 When a client is dehydrated, they will have an elevated BUN.

05:04 So whether the severe dehydration comes from a burn injury or just being, like, over-diuresed or they were out doing two a days in Oklahoma heat, whatever it is, severe dehydration, look for a BUN level that's elevated.

05:20 So, yes. Number three is the correct answer because that's what most likely contributed to a higher than normal BUN level.

05:30 Now, you're ready for the next question.