The nurse reviews a client's laboratory results for a client admitted with gastrointestinal (GI) bleeding who has no visible hemorrhoids on inspection of the anal area. Which laboratory test indicates that the client's bleeding is not yet resolved?Reference Range:
Hematocrit (Hct) [42% to 52% (0.42 to 0.52 volume fraction)]
Prothrombin time (PT) [11.0 to 12.5 seconds (85%-100%)]
Glycosylated hemoglobin (A1C) [4% to 5.9%]

Guaiac test changes from positive to negative.

Hematocrit changes from 36% to 32%.

Prothrombin time (PT) changes from 12 seconds to 18 seconds.

Hemoglobin A1C changes from 10% to 8%.

Answer and Explanation

The Correct Answer is B

A. Guaiac test changes from positive to negative: The guaiac test detects occult blood in stool. A negative result after being positive suggests that the bleeding has stopped, but it does not directly reflect the resolution of bleeding as hematocrit and hemoglobin levels would. While useful for identifying ongoing bleeding, it is not the most reliable indicator of blood volume loss over time.

B. Hematocrit changes from 36% to 32%: A decrease in hematocrit, from 36% to 32%, indicates a loss of red blood cells and suggests that the client’s GI bleeding has not yet resolved. The hematocrit is a direct reflection of blood volume and RBC concentration, so a decline would point to continued blood loss, especially in the setting of GI bleeding.

C. Prothrombin time (PT) changes from 12 seconds to 18 seconds: An increased PT suggests a clotting issue, possibly related to liver dysfunction or anticoagulant therapy. However, PT changes are not a direct indicator of blood loss resolution in the setting of GI bleeding. While it may indicate an issue with coagulation, it is not the best indicator of ongoing blood loss.

D. Hemoglobin A1C changes from 10% to 8%: Hemoglobin A1C is a test for long-term blood glucose control and is unrelated to acute bleeding events. A change in A1C levels would indicate changes in glucose control, not blood loss or resolution of bleeding, making it irrelevant to this scenario.

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Correct Answer is D

Explanation

A. "Count backwards by 7, starting with 100.": This question assesses concentration, attention span, and mathematical ability but does not evaluate abstract thinking. It is typically used in cognitive or mental status exams to assess focus and processing speed.

B. "Has anyone come to visit you today?": This is a straightforward question assessing recent memory or orientation but has no abstract component. It provides little insight into higher-order thinking or interpretation skills.

C. "In what year were you born?": This question evaluates remote memory, not abstract reasoning. It is factual and concrete, requiring only recollection, not interpretation or deeper thought.

D. "What does, 'The early bird catches the worm,' mean?": This is a proverb that requires interpretation beyond its literal meaning. Asking for its meaning helps assess abstract thinking by evaluating the client’s ability to understand figurative language and draw broader conclusions.

A. An odorless, red menstrual blood flow. B. Cramping associated with the amount of flow. C. Blood clots sized at 0.5 cm (0.2 in) with menstrual flow. D. Blood saturation of one pad an hour.

Correct Answer is D

Explanation

A. An odorless, red menstrual blood flow: This is considered a normal characteristic of menstruation. Menstrual blood may have a slight metallic scent due to the mixing with vaginal secretions, but an odorless red flow is not a concern and does not suggest abnormality.

B. Cramping associated with the amount of flow: Mild to moderate cramping (dysmenorrhea) is a common and expected part of menstruation related to the release of prostaglandins that cause uterine contractions especially during heavier flow days. While it can be uncomfortable, it is not typically considered abnormal unless severe or disabling.

C. Blood clots sized at 0.5 cm (0.2 in) with menstrual flow: Small blood clots can occur during menstruation, especially during heavier flow, and clots under 1 inch (2.5 cm) in diameter are generally not worrisome. This size is within normal limits and not an indication of a menstrual disorder.

D. Blood saturation of one pad an hour: This finding suggests menorrhagia, or abnormally heavy menstrual bleeding. Saturating a pad or tampon every hour for several consecutive hours is clinically significant and warrants further investigation, as it can lead to anemia and may signal an underlying gynecological issue such as fibroids or a bleeding disorder.

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Naxlex Comprehensive Predictor Exams

The nurse plans to assess a client's ability to think abstractly. Which question or statement is likely to provide the best information about the client's abstract thinking?

Correct Answer is D

Explanation

The nurse examines a client who is concerned about the amount of menstrual flow she is having. Which finding indicates an abnormality related to the client's current menstruation?

Correct Answer is D

Explanation

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