A nurse is reviewing a client's laboratory results and sees that their hemoglobin A1C is 9%. Which of the following statements from the nurse is appropriate?

"Your blood sugar is very unstable."

"Your blood sugar is too high after meals."

"Your average blood sugar is high."

"You have many dangerously low blood sugar levels."

Answer and Explanation

The Correct Answer is C

A. "Your blood sugar is very unstable." While high HbA1C levels can indicate poor glucose control, they do not specifically indicate instability in blood sugar levels (i.e., frequent fluctuations between high and low levels). HbA1C does not capture short-term variations in blood glucose; it only provides an average over a few months.

B. "Your blood sugar is too high after meals." Although postprandial (after-meal) glucose levels contribute to overall blood glucose levels, HbA1C measures the average blood glucose level over several months and is not specific to postprandial glucose levels. A high HbA1C suggests elevated glucose levels overall, not just after meals.

C. "Your average blood sugar is high." HbA1C measures the average blood sugar level over an extended period, typically 2-3 months. A result of 9% indicates that the client's average blood glucose levels have been consistently high, suggesting poor long-term glucose control. This is a precise and appropriate statement reflecting the meaning of the HbA1C result.

D. "You have many dangerously low blood sugar levels." A high HbA1C indicates elevated blood glucose levels over time, not low levels. Low blood sugar levels (hypoglycemia) would not contribute to a high HbA1C. In fact, frequent hypoglycemia would more likely result in a lower HbA1C, not a higher one.

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Correct Answer is C

Explanation

A. Increased pulmonary artery wedge pressure (PAWP): PAWP measures left atrial pressure, which is typically increased in left-sided heart failure, not right-sided. Right-sided heart failure leads to systemic congestion rather than pulmonary congestion.

B. Decreased specific gravity: Specific gravity measures urine concentration. It is not a primary indicator of heart failure. Heart failure usually affects fluid balance rather than specific urine concentration.

C. Elevated central venous pressure (CVP): CVP reflects the pressure in the right atrium and central veins, which is elevated in right-sided heart failure due to the backup of blood in the systemic circulation. This results in increased venous pressure.

D. Decreased brain natriuretic peptide (BNP): BNP levels are typically elevated in heart failure, as they reflect the degree of ventricular stretching and fluid overload. A decrease would not be expected in acute heart failure.

A. Purple striations B. Hirsutism C. Intention tremors D. Hyperpigmentation

Correct Answer is D

Explanation

A. Purple striations: Purple striations are characteristic of Cushing's syndrome due to prolonged exposure to high levels of cortisol. They are not associated with Addison's disease, which involves adrenal insufficiency and low cortisol levels.

B. Hirsutism: Hirsutism, or excessive hair growth, is not a feature of Addison's disease. It is more commonly associated with conditions involving high androgen levels, such as polycystic ovary syndrome or Cushing's syndrome.

C. Intention tremors: Intention tremors are associated with neurological conditions like multiple sclerosis or essential tremor, not Addison's disease. Addison's primarily affects hormone levels and fluid balance.

D. Hyperpigmentation: Hyperpigmentation, particularly in areas like the skin creases, gums, and around scars, is a hallmark sign of Addison's disease. It is due to increased production of melanocyte-stimulating hormone (MSH) as a result of elevated levels of adrenocorticotropic hormone (ACTH).

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