Nokea
The nurse is reviewing the laboratory results of a client scheduled for surgery. Which of the following should be reported to the primary health care provider (PHCP)?
- A. Glycosylated hemoglobin (HbA1c) of 7.2% [5.7-6.4%]
- B. International Normalized Ratio (INR) of 3.5 [0.9-1.2 seconds]
- C. Hematocrit (Hct) of 42% [Male: 42-52% Female: 37-47%]
- D. Blood urea nitrogen (BUN) level of 5 [10-20 mg/dL]
Correct Answer: B
Rationale: An INR of 3.5 indicates a high bleeding risk, critical for surgical safety, and must be reported to the PHCP. Elevated HbA1c, normal hematocrit, and low BUN are less urgent but may still require attention.
You may also like to solve these questions
The nurse is assisting a client with the use of a fracture bedpan. Which action should the nurse take?
- A. Position the client prone while placing the bedpan.
- B. Raise the head of the bed to 30 degrees.
- C. Place the open rim of the bedpan toward the head of the bed.
- D. Lower all of the side rails
Correct Answer: B
Rationale: Raising the head of the bed to 30 degrees facilitates client comfort and proper positioning for a fracture bedpan. Prone positioning is incorrect, the open rim faces the foot of the bed, and lowering all side rails is unsafe.
The nurse is caring for a client with an indwelling urinary catheter connected to a drainage bag. The nurse demonstrates effective care when. Select all that apply.
- A. Emptying the drainage bag when it is half full.
- B. Collecting a urine specimen for culture from the port in drainage tubing.
- C. Clamping the urinary catheter tubing prior to discontinuation.
- D. Instructing the client to carry the collection bag above their bladder during ambulation.
- E. The tubing goes in and out of the urethra during cleaning.
Correct Answer: A,B
Rationale: Emptying when half full prevents reflux, and collecting from the port ensures sterility. Clamping is unnecessary, carrying above the bladder risks reflux, and tubing movement risks infection.
The purpose of a health assessment is to:
- A. Obtain subjective and objective data
- B. Outline appropriate care
- C. Determine whether interventions are effective
- D. Intervene to correct difficulties
Correct Answer: A
Rationale: Health assessments collect subjective and objective data to inform care planning. Outlining care, evaluating interventions, or correcting issues are subsequent steps.
The nurse performs a home safety survey for an older adult. Click to specify the findings that require intervention by the nurse.
- A. Scatter rugs at the end of the stairs
- B. Smoke detector present without a battery
- C. Stairs present with sturdy hand rails
- D. New light fixtures installed and connected in a grounded electrical outlet
- E. Extension cord covered with an anti-skid area rug
- F. Unlabeled household chemicals under the sink
- G. Fire extinguisher present 30 feet from the stove
Correct Answer: A,B,E
Rationale: Scatter rugs and extension cords pose trip hazards, and a non-functional smoke detector is a fire risk. Unlabeled chemicals risk poisoning, requiring intervention.
The nurse is performing community health screenings. A client tells the nurse that they smoke two packs a day of cigarettes and they have smoked for the past six years. How should the nurse document the Pack-years this client has smoked?
- A. 3.5 pack years
- B. 3 pack years
- C. 12 pack years
- D. 6 pack years
Correct Answer: C
Rationale: Pack-years = packs per day × years smoked = 2 × 6 = 12 pack-years. Other calculations are incorrect.