A physician has ordered a check of glycosylated hemoglobin (HbA1c) levels for a client with diabetes. Which statement by the client regarding this test indicates that teaching has been effective?

Choice A rationale: Glycosylated hemoglobin, or HbA1c, is a blood test that provides an average of blood glucose levels over the preceding 2 to 3 months. It reflects the amount of glucose irreversibly attached to hemoglobin in red blood cells. Therefore, it is a crucial long-term indicator for monitoring the effectiveness of a client's diabetes management and treatment plan.
Choice B rationale: While HbA1c is used to diagnose diabetes, a single reading is often not enough. The primary purpose of this test once a client is diagnosed is to assess the long-term control of their blood glucose levels and guide adjustments in treatment, not to rediagnose the disease.
Choice C rationale: The HbA1c test measures the percentage of hemoglobin with attached glucose. Although anemia can affect the results by altering the red blood cell lifespan, the test itself is not used to diagnose anemia. Anemia is typically diagnosed through a complete blood count (CBC), which assesses hemoglobin, hematocrit, and red blood cell counts.
Choice D rationale: The HbA1c test reflects average blood glucose levels over the preceding 2 to 3 months, not just the previous 3 weeks. Red blood cells have a lifespan of approximately 120 days, and glucose attaches to the hemoglobin for the entire duration of the cell's life, providing a long-term picture of glycemic control.

Choice A rationale: Encouraging incentive spirometry is a pulmonary intervention designed to prevent atelectasis and pneumonia by promoting deep breathing. While important post-surgically, it does not address the metabolic emergency indicated by the fruity breath odor, which is a classic sign of excessive ketone production from fat metabolism due to severe insulin deficiency.
Choice B rationale: Increasing intravenous fluids could worsen fluid overload in a dehydrated client without addressing the underlying metabolic imbalance. Although fluid resuscitation is part of the treatment for severe hyperglycemia, the primary intervention involves insulin administration to correct the metabolic derangement and halt ketone production, which is the root cause of the fruity odor.
Choice C rationale: The fruity breath odor is caused by the exhalation of acetone, a type of ketone body produced during lipolysis when glucose is unavailable for cellular energy. This indicates the body is in a state of ketoacidosis, a life-threatening complication of uncontrolled diabetes. Consulting the provider for immediate testing and treatment is the priority action.
Choice D rationale: Performing meticulous pulmonary hygiene, such as suctioning and chest physiotherapy, is indicated for clients with respiratory secretions or compromised lung function. While important for general post-operative care, it does not address the specific metabolic emergency of ketoacidosis indicated by the fruity breath odor, which requires immediate medical intervention.