Four clients have new lab results. Which result requires immediate action?

A. Cholesterol of 238 mg/dL in a client on a statin
B. INR of 2.6 in a client taking warfarin for atrial fibrillation
C. Glucose of 42 mg/dL in a client receiving insulin
D. Hemoglobin A1C of 7.8% in a client with type 2 diabetes

Show answer and rationale

Correct answer: C

Severe hypoglycemia can cause seizures and brain injury and needs immediate treatment. The others need follow-up but aren't emergencies; an INR of 2.6 is therapeutic for atrial fibrillation.

Source: ADA. Standards of Care in Diabetes, Section 6 (hypoglycemia)

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This question is one of 193 Management of Care items in NCLEXSim. On the NCLEX-RN, this category makes up 15–21% of the exam.

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Study tip

Work every 'who first' item through the same ladder: airway, breathing, circulation; then unstable before stable, acute before chronic, actual before potential.
Delegation: the RN keeps initial assessment, care planning, teaching, evaluation, and any unstable client. LPNs take stable, predictable clients. Assistive personnel take routine tasks such as vital signs on stable clients, hygiene, feeding without swallowing risk, and ambulation.

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Four clients have new lab results. Which result requires immediate action?

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