Nokea
A diabetic client asks the nurse why the provider ordered a glycosylated hemoglobin (HbA) measurement, since a blood glucose reading was just performed. You will explain to the client that the HbA test:
- A. Provides a more precise blood glucose value than self-monitoring
- B. Is performed to detect complications of diabetes
- C. Measures circulating levels of insulin
- D. Reflects an average blood sugar for several months
Correct Answer: D
Rationale: Glycosylated hemoglobin values reflect the average blood glucose (hemoglobin-bound) for the previous 2-3 months and can be used to monitor client adherence to the therapeutic regimen.
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The nurse is caring for a client who is receiving heparin 5,000 units subcutaneously every 12 hours. Which of the following laboratory results would be of GREATest concern to the nurse?
- A. Platelet count of 100,000/mm^3.
- B. INR of 1.2.
- C. PTT of 40 seconds.
- D. Hemoglobin of 14 g/dL.
Correct Answer: A
Rationale: A platelet count of 100,000/mm^3 suggests thrombocytopenia, a serious complication of heparin therapy, increasing bleeding risk and possibly indicating heparin-induced thrombocytopenia. Options B, C, and D are normal or less concerning: INR and PTT are not significantly affected by subcutaneous heparin, and hemoglobin 14 g/dL is normal.
An adult who was struck by lightning is brought to the emergency department. Which action is of highest priority when the client is brought to the emergency room?
- A. Obtain an ECG
- B. Check blood gasses
- C. Dress wounds
- D. Check electrolytes
Correct Answer: A
Rationale: Lightning strikes can cause cardiac arrhythmias; obtaining an ECG is the highest priority to detect life-threatening rhythm disturbances. Gases, wounds, and electrolytes are secondary.
The nurse asks a client with a history of alcoholism about recent drinking behavior. The client states 'I didn't hurt anyone. I just like to have a good time, and drinking helps me to relax.' The client is using which defense mechanism?
- A. Denial
- B. Projection
- C. Intellectualization
- D. Rationalization
Correct Answer: D
Rationale: Rationalization. The client justifies drinking by providing acceptable explanations for unacceptable behavior.
The nurse is caring for a client with a history of ulcerative colitis.
- A. Which laboratory finding is most concerning for a client with ulcerative colitis?
- B. Hemoglobin of 10.5 g/dL.
- C. White blood cell count of 15,000/mm³.
- D. Serum potassium of 3.8 mEq/L.
- E. Albumin of 3.0 g/dL.
Correct Answer: B
Rationale: A white blood cell count of 15,000/mm³ suggests infection or severe inflammation in ulcerative colitis, requiring immediate attention. Low hemoglobin and albumin are common, and normal potassium is unremarkable.
The nurse is teaching a woman the normal changes of pregnancy. Which statement by the woman indicates correct understanding?
- A. There is decreased oxygen consumption during pregnancy.'
- B. There is an increased rate of peristalsis in the GI tract.'
- C. I will have a 50% increase in blood volume.'
- D. My metabolic rate will decrease.'
Correct Answer: C
Rationale: Pregnancy increases blood volume by about 50% to support fetal circulation, a correct understanding. Oxygen consumption and metabolic rate increase, and peristalsis slows.