Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
15. Which client has the best control of diabetes?
Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
15. Which client has the best control of diabetes?
. A client who has trouble sticking to diet and exercising but takes meds regularly. FBS is 132 mg/dL, HgbA1c is 11%.
. A client who has perfect compliance with diet, exercise, and meds. FBS is 96 mg/dL, HgbA1c is 11%.
. A client whose diabetes is controlled with diet alone. FBS is 452 mg/dL, HgbA1c is 12%.
. A client who has trouble remembering meds, but good compliance with diet and exercise. FBS is 110 mg/dL, HgbA1c is 7%.
Test-Taking Tip
HgbA1c is the best indication of compliance. Three of the options are very close in value. Choose the lowest HgbA1c as an example of "best" control.
Content Area: Adult Health, Endocrine; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
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Answer 1 is incorrect because this client has an A1c of 11%, indicating average blood sugars of about 300 mg/dL over the last 3 months. Regardless of client's statement of compliance and the immediate fasting blood sugar of 132, the disease, on average, has been out of control for months. Answer 2 is incorrect because the client claims to be compliant with diet, medications, and exercise, and the normal fasting blood sugar is consistent with this. Looking at the A1c shows that, on average, the client's blood sugar has been about 300 mg/dL over the last 3 months. Answer 3 is incorrect because this client is only using diet for diabetes management. The high fasting blood sugar and A1c indicate that this is clearly not enough. Answer 4 is correct because the A1c measures average blood sugar over the previous 3 months. The goal is less than 7%. Short-term compliance can give the client a normal fasting blood sugar, but this is not considered good control of the disease.