A female patient comes in OPD routine checkup. Her random blood sugar (RBS) level on 2 different occasion are 110 mg/dl and 113 mg/dl. On the basis of the RBS result the nurse would write what diagnosis in the patient record?

1. A

   HbA1c

2. B

   Diabetic

3. C

   OGTT

4. D

   Normal

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)

Explanation

Listen in Hindi

• The patient's Random Blood Sugar (RBS) levels of 110 mg/dl and 113 mg/dl fall within the accepted normal range.
• According to American Diabetes Association (ADA) guidelines, a random plasma glucose level below 140 mg/dL is considered normal.
• A diagnosis of diabetes based on a random sample requires a value of 200 mg/dL or greater, typically accompanied by classic symptoms of hyperglycemia (e.g., polyuria, polydipsia).
• Since the patient's values are well below this threshold and the visit is for a routine checkup, the finding is correctly documented as normal.

Why Other Options Were Wrong

• Option A: HbA1c (Glycated Hemoglobin) is a laboratory test that measures the average blood glucose over the past 2-3 months. It is a tool for diagnosis and monitoring, not a diagnosis itself.
• Option B: This diagnosis is incorrect because the patient's RBS values of 110 and 113 mg/dl do not meet the established diagnostic criteria for diabetes mellitus, which is an RBS of 200 mg/dl or higher with symptoms.
• Option C: The Oral Glucose Tolerance Test (OGTT) is a specific diagnostic procedure used to assess how the body processes a glucose load. It is a test, not a final diagnosis.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Interpretation of Random Blood Sugar (RBS) results for diabetes screening to guide bedside assessment, documentation, and the next nursing action.
• Accurate interpretation of blood glucose levels is a fundamental nursing skill essential for effective screening, patient education, and identifying the need for further medical evaluation.
• Nurses play a crucial role in communicating routine lab results to patients, which helps in alleviating anxiety, promoting health literacy, and encouraging healthy lifestyle choices.
• What if? If one of the patient's RBS readings was 160 mg/dl, while not diagnostic of diabetes, it would be considered elevated and abnormal. The nurse should then anticipate an order for further testing, such as a Fasting Plasma Glucose or an HbA1c, to rule out prediabetes or diabetes.

How to Approach the Question

• First, identify the key clinical data provided: The test is a Random Blood Sugar (RBS) and the levels are 110 mg/dl and 113 mg/dl.
• Second, recall the standard diagnostic criteria for blood glucose levels. Specifically, what is the normal range for an RBS test?
• Third, compare the patient's values to the established ranges. Note that an RBS less than 140 mg/dl is considered normal.
• Fourth, evaluate the options. Recognize that 'HbA1c' and 'OGTT' are names of tests, not diagnoses.
• Fifth, eliminate the 'Diabetic' option as the patient's values are far below the diagnostic threshold of 200 mg/dl or higher.
• Conclude that 'Normal' is the only appropriate description for these findings based on the provided data.

Concept Tested & Keywords

• Concept Tested: Interpretation of Random Blood Sugar (RBS) results for diabetes screening.
• Stem keywords: random blood sugar, RBS, 110 mg/dl, 113 mg/dl, diagnosis
• Lead-in keywords: what diagnosis
• Clinical cues: Routine checkup implies the patient is likely asymptomatic.
• Negative lead-in flag: false

Question ID

Q-U5SCDwBP53TClF_ueftR

Copy ID

Reference Book

E6 PATHOLOGY QUICK REVIEWBased on Harsh Mohan Textbook of PATHOLOGY p. 251-253

E6 Pharmacology Katzung 16e p. 1173-1175