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%]

Hematocrit changes from 36% to 32%.

Hemoglobin A1C changes from 10% to 8%.

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

Guaiac test changes from positive to negative.

Answer and Explanation

The Correct Answer is A

A.   A decrease in hematocrit from 36% to 32% suggests ongoing blood loss and that the client’s GI bleeding has not yet resolved. Hematocrit is a key indicator of the client’s blood volume and oxygen- carrying capacity.
B.   Hemoglobin A1C reflects long-term blood sugar control, not current blood loss. A change in A1C is not indicative of GI bleeding resolution.
C.   An increase in prothrombin time (PT) from 12 to 18 seconds indicates clotting abnormalities, which may occur with liver dysfunction or anticoagulant therapy, but it doesn't directly relate to GI bleeding resolution.
D.   A positive to negative change in the guaiac test (fecal occult blood test) would indicate that the blood in the stool is no longer present, suggesting resolution of bleeding, which doesn’t match the question’s context.

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Correct Answer is D

Explanation

A. Frozen or non-movable joints typically refer to severe joint damage such as in cases of rheumatoid arthritis or advanced osteoarthritis, but Heberden's nodes are characterized by bony growths at the distal interphalangeal joints and do not indicate frozen joints.
B. Heberden's nodes are bony enlargements found at the distal interphalangeal joints. However, they are not typically associated with deviation of the joints, which might occur with other conditions like rheumatoid arthritis.
C. Proximal intertarsal joint swelling, particularly of the big toe, is more likely associated with gout, not osteoarthritis. Heberden's nodes specifically refer to changes in the distal interphalangeal joints of the fingers.
D. Heberden's nodes are typically non-painful enlargements of the distal interphalangeal joints that result from osteoarthritis. The nurse should document the presence of these nodes and note if they are non-painful.

A. History of a fractured patella. B. Needle aspiration of the synovial space. C. Knee arthroplasty surgery. D. Degenerative disease.

Correct Answer is D

Explanation

A. A history of a fractured patella could potentially cause crepitation if there were long-term damage or improper healing. However, it is more likely that crepitation is related to degenerative changes, such as osteoarthritis.
B. Needle aspiration of the synovial space may have been performed to relieve fluid buildup or inflammation, but it would not directly explain the crepitation in the joint. Crepitation is more commonly seen in conditions that affect cartilage or joint surfaces.
C. Crepitation following knee arthroplasty is possible if there are complications, but it is more likely due to arthritis or degenerative joint disease if the patient has not undergone surgery. Arthroplasty would usually be associated with reduced crepitation.
D. Degenerative diseases, such as osteoarthritis, are the most likely cause of crepitation. As the cartilage wears away, the bone surfaces rub together, causing the characteristic crunching or grating sound when the joint is moved.

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Naxlex Comprehensive Predictor Exams

During a health assessment, the client reports being treated for osteoarthritis. The nurse examines a client's hands and finds Heberden's nodes. Which finding should the nurse document in the client's medical record?

Correct Answer is D

Explanation

When assessing a client's range of motion, the nurse notes crepitation with movement of the left knee. Which information in the client's history is most likely related to this finding?

Correct Answer is D

Explanation

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