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What do you guys think of this test question

A client's results on his Hgb a1c are an 8. As the nurse what would you evaluate with the client concerning this score

a. what had for breakfast before he had his blood drawn

b. recent illness

c. wounds or injuries

d. dont remember this answer but it is irrelevant anyway.

I just want to see what answer you guys rationalize out of this test question, before I decide to expend a lot of time and energy trying to research the answer for that dang point.

Specializes in Family Nurse Practitioner.

Any idea what D. was? I don't like to discount anything without seeing it. :)

Specializes in med/surg, telemetry.

I'd probably lean toward picking answer C because the main reasons that the A1C can give negative results are things that cause a high turnover rate of the red blood cells like:

Severe bleedings, hemolitic anemia, splenectomy,

high doses of vitamin C, high concentrations of

ethanol, lead, poissoning, and some persons with special

types of hemoglobin.

I don't think I'd be as apt to lean toward wondering what they ate for breakfast because of the test showing an overall food consumption for the last 3 months is what gives the results. The previous month before the test is responsible for 50% of the obtained test result. So I'd probably be looking for injuries or illnesses that would cause a high turnover rate of RBC's.

I already know the answer to the question the professors are going with, so honestly d does not matter.

I'm not sure if I know the answer to this or not but from what I recall (and I'm all about recall these days w/ HESI looming large)... anything over 5 was high and indicative of poor glucose control for the past 3-4 mos. I think the answer is to assess recent illnesses because blood sugar can get high with stress, illness and some meds (steroids for example).

Let us know what the right answer is!

Specializes in Med/Surg, ICU, ER, Peds ER-CPEN.

I can see a validity to each answer, since it measure avg glucose over past 120 days, what the pt ate for breakfast wouldn't have affected the result but may show a dietary trend, for recent illness - some kidney and liver diseases can alter the Hgb a1c levels, and wounds or injuries because diabetics heal much slower, it's possible the pt being tested may not realize they were diabetic prior to the test, it's possible that answer D had some relevance too. this is by far one of the more tricky questions I've come across, what was the correct answer? if it were my exam I'd probably have gone with wounds or injuries.

Specializes in med surg/tele.

I would choose B. because illness raises blood glucose and can cause higher than normal readings.

Specializes in med/surg, telemetry, IV therapy, mgmt.
A client's results on his Hgb a1c are an 8. As the nurse what would you evaluate with the client concerning this score

a. what had for breakfast before he had his blood drawn

b. recent illness

c. wounds or injuries

d. dont remember this answer but it is irrelevant anyway.

HBG-A1C, or glycosylated hemoglobin, measures the average combination of glucose and hemoglobin in the lifespan of an RBC. An RBC has a lifespan of 3 months or 120 days. The blood sample, however, will contain blood cells that will be from 1 to 120 days old, so the test will be an average of the glycosylated hemoglobin these cells contain. 4 to 5.5% is considered normal per my reference for HBG-A1C (page 707, Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications, 2nd edition, by Anne M. Van Leeuwen, Todd R., Kranpitz and Lynette Smith). The amount of glycosylated hemoglobin depends on the amount of glucose that was available in the bloodstream over the lifespan of each individual RBC. That is why the value obtained is an average of all the RBCs in the sample that is tested. Therefore, the more glucose the RBCs were exposed to is going to give you a higher result.

So, the question becomes one of which answer choice would have resulted in causing the body to have higher glucose levels over a longer period of time. Answer choice "A" is an automatic deletion since the HBG-A1C is not affected by short-term variations or what is happening with the blood sugar that particular day and can be drawn at any time during the day. But, answer choices "B" and "C" are possibilities. The dilemma, then, is which choice is going to cause the rise in glycosylated hemoglobin over the longer length of time.

My personal feeling is that "recent" illness would eliminate choice "B" since it contains the word "recent" and this test is measuring glycosylated hemoglobin over an averaged period of time. Answer choice "C" looks a lot more likely to me although it doesn't elaborate about the "wounds and injuries". So, by default, I'd go with answer choice "C".

Something else the problem doesn't mention is diabetes, so you don't want to assume that the patient is diabetic, although this test is primarily known to be increased in patients with diabetes and most commonly done on diabetics. However, I have another reference that says this test is elevated in acute stress response, Cushing's syndrome, pheochromocytoma, glucagnoma, corticosteroid therapy or acromegaly (page 451, Mosby's Diagnostic and Laboratory Reference, 4th edition, by Kathleen Deska Pagana and Timothy James Pagana). If this patient were a diabetic, I would feel much better about answer choice "C".

What was the reason you didn't want to spend the time and energy to research the answer, I'm really curious to know?

Specializes in Med/Surg <1; Epic Certified <1.

My choice would've been B, with C a close runner up.

What was the prof's "correct" answer?!?!?

Specializes in Nursing Professional Development.

I am also curious as to what the professor says is the "correct" answer and rationale. I don't like any of the 3 possible answers given. If forced to choose, I would choose B for the reasons others have mentioned.

But what is a "recent" illness? ... a day ago? a week ago? a month ago? A minor sore throat last week is unlikely to have much effect on the HbA1c. However, a longer-lasting infection is a different story. Similarly, with a wound or injury -- was is a minor injury 2 days ago or a serious one 6 weeks ago? As for breakfast that morning, it's unlikely to be the answer because it is probably NOT what they are looking for as the breakfast would not effect the test. However, assessing the patient's usual eating patterns would be very helpful in establishing the likelihood of diabetes. As Daytonite explained, the HbA1c is a big part in of diabetes diagnosis and management.

As a professor, I think this is a LOUSY test question. Even those of us who well understand the test and its uses aren't sure what the professor is looking for.

Specializes in Education, FP, LNC, Forensics, ED, OB.
as for breakfast that morning, it's unlikely to be the answer because it is probably not what they are looking for as the breakfast would not effect the test. however, assessing the patient's usual eating patterns would be very helpful in establishing the likelihood of diabetes.

excellent point. might offer insight to what this individual eats on an every day basis.........

have to agree with the others; poor question. 'b' is my answer for reasons given.

but, still wonder what 'd' was.......??

Specializes in MPCU.

I like answer 'c' because wound healing would be affected by high average glu levels. but the reason for the high level could be 'A' or 'B'.

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