The nurse in a clinic reviewing laboratory results for a patient suspected of having undiagnosed diabetes mellitus. Which of the following results would be diagnostic for diabetes

Fasting plasma glucose of 98mg/dl

Hemoglobin A1C (glycosylated hemoglobin) of 7.2%

Random plasma glucose of 110 mg/dl

Two hour plasma glucose of 140mg/dl

Answer and Explanation

The Correct Answer is B

A) Fasting plasma glucose of 98 mg/dl:
A fasting plasma glucose level of 98 mg/dl is within the normal range (70–99 mg/dl). According to diagnostic criteria, a fasting plasma glucose level of 100–125 mg/dl is considered prediabetes, and 126 mg/dl or higher on two separate occasions is diagnostic for diabetes. Therefore, a fasting plasma glucose of 98 mg/dl is not diagnostic for diabetes.

B) Hemoglobin A1C (glycosylated hemoglobin) of 7.2%:
An HbA1C level of 7.2% is diagnostic for diabetes. The American Diabetes Association (ADA) defines diabetes as an HbA1C of 6.5% or higher. The HbA1C test reflects the average blood glucose level over the past 2–3 months, and a level of 7.2% indicates that the patient's blood glucose levels have been elevated over time, consistent with diabetes. This is a key diagnostic criterion.

C) Random plasma glucose of 110 mg/dl:
Although a random glucose value greater than 200 mg/dl with symptoms of hyperglycemia can be diagnostic of diabetes, 110 mg/dl is within the normal range and does not meet the criteria for a diabetes diagnosis. For diagnostic purposes, a random plasma glucose must be 200 mg/dl or higher.

D) Two hour plasma glucose of 140 mg/dl:
For the test to be diagnostic of diabetes, the plasma glucose must be 200 mg/dl or higher after two hours. A level of 140 mg/dl suggests normal glucose tolerance or prediabetes, but it is not diagnostic for diabetes.

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Correct Answer is A

Explanation

A) Obtain a 12-lead ECG:
The client’s potassium level of 6.6 mEq/L is significantly elevated which places the patient at risk for cardiac arrhythmias. Elevated potassium levels can cause dangerous changes in the electrical activity of the heart, leading to peaked T waves, widened QRS complexes, and even cardiac arrest. A 12-lead ECG is necessary to assess the heart's electrical activity and to identify any potential arrhythmias

B) Request an electroencephalogram (EEG):
An EEG is used to assess brain activity and is typically indicated for conditions such as seizures or epilepsy. This client’s laboratory findings do not suggest a neurological concern that would warrant an EEG.

C) Assess for Chvostek's sign:
Chvostek's sign is used to assess for hypocalcemia or tetany, where a twitching of the facial muscles occurs upon tapping the facial nerve. However, the client’s primary issue here is elevated potassium levels, which are a more immediate concern than hypocalcemia. Hyperkalemia can have more severe and urgent consequences, particularly for the heart, so Chvostek's sign is not the priority at this time.

D) Obtain a chest X-ray:
A chest X-ray is not indicated based on the client’s current electrolyte imbalance or renal failure status. While a chest X-ray may be useful for various other concerns, the client’s elevated potassium level is the primary issue, and the priority intervention is to assess and manage the potential for cardiac arrhythmias with a 12-lead ECG.

A. I will notify my doctor before taking any other medications’’ B. "I should talk to my doctor about other methods of contraception in addition to my current oral contraceptives. C. "I'll be glad when I can stop taking this medicine after my seizures are controlled’’ D. I have made an appointment to see my dentist next week.’’

Correct Answer is C

Explanation

A) "I will notify my doctor before taking any other medications:"
Phenytoin interacts with many medications, both prescription and over-the-counter. It is crucial for the client to inform their doctor before starting any new medications, including herbal supplements, as phenytoin may have significant drug interactions that could alter its effectiveness or increase the risk of side effects.

B) "I should talk to my doctor about other methods of contraception in addition to my current oral contraceptives:"
Phenytoin can decrease the effectiveness of oral contraceptives, leading to an increased risk of unintended pregnancy. It is important for clients to discuss alternative or additional methods of contraception, such as non-hormonal methods or alternative hormonal birth control, with their healthcare provider to prevent pregnancy while taking phenytoin.

C) "I'll be glad when I can stop taking this medicine after my seizures are controlled:"
Phenytoin is typically a lifelong medication for managing seizures, even if the seizures are well-controlled. Stopping the medication without a doctor's approval can lead to seizure recurrence. Seizure control does not always mean stopping medication, and clients need to understand the importance of continuing the prescribed treatment regimen, even after achieving stability.

D) "I have made an appointment to see my dentist next week:"
Phenytoin can cause gingival hyperplasia, which increases the need for regular dental checkups. It is recommended that clients taking phenytoin see a dentist regularly to manage this potential side effect and maintain oral health.

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The nurse in a clinic reviewing laboratory results for a patient suspected of having undiagnosed diabetes mellitus. Which of the following results would be diagnostic for diabetes

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