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. White, curd-like lesions: These are often indicative of oral candidiasis (thrush), a fungal infection that may require antifungal treatment. While it needs follow-up, it is not typically emergent unless the patient is immunocompromised.

B. Gingival inflammation: This suggests gingivitis or periodontal disease and warrants dental evaluation, but it does not pose an immediate systemic risk unless associated with infection or abscess.

C. Buccal mucosa ulceration: Ulcerations can result from trauma, infection, or systemic conditions. They require assessment and possibly treatment but do not usually demand urgent intervention unless severe or rapidly worsening.

D. Fruity odor of the breath: A fruity or sweet breath odor can be a sign of diabetic ketoacidosis (DKA), a life-threatening complication of uncontrolled diabetes. It requires immediate medical attention due to the risk of severe metabolic imbalance and potential for rapid deterioration.

A. Lower body mass index (BMI). B. Diminished appetite. C. Decreased height. D. 15 lb (6.8 kg) weight loss.

Correct Answer is C

Explanation

A. Lower body mass index (BMI): A lower BMI is a known risk factor for osteoporosis, especially in older adults. However, on its own, it does not immediately trigger the need for a bone density scan unless accompanied by other risk indicators like fractures or height loss.

B. Diminished appetite: Loss of appetite may contribute to poor nutritional intake, including calcium and vitamin D, which can impact bone health over time. Still, this symptom alone does not directly prompt a bone density screening without other supporting signs.

C. Decreased height: A measurable decrease in height may suggest vertebral compression fractures, a hallmark of osteoporosis. This is a key indicator that warrants further evaluation with a bone density scan (DEXA) to assess for bone loss.

D. 15 lb (6.8 kg) weight loss: While unintentional weight loss may be a concern for many conditions, including cancer or malnutrition, it is not a specific trigger for bone density testing unless associated with other risk factors or signs of bone demineralization.

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Naxlex Comprehensive Predictor Exams

When assessing a client's mouth, which finding requires immediate follow-up by the nurse?

Correct Answer is D

Explanation

During a routine health screening of an adult female, the nurse notes several changes that have occurred over the past year. Which change indicates the need for a bone density screening?

Correct Answer is C

Explanation

An adult male client tells the nurse that he smokes approximately one pack of cigarettes daily. How can the nurse expect smoking to affect this client's sleep?

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