A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?
Perform a blood sugar analysis.
Have the client drink a 4-ounce (120-mL) glass of orange juice.
Administer 1 ampule of 50% dextrose intravenously.
Administer 10 units of regular insulin subcutaneously.
The Correct Answer is B
A. Performing a blood sugar analysis is important, but in the case of sudden symptoms such as weakness, shakiness, and dizziness, it is crucial to act quickly to address the potential hypoglycemia without delay.
B. Having the client drink a 4-ounce glass of orange juice is the most appropriate initial response as it provides a quick source of glucose to alleviate symptoms of hypoglycemia, which is a common concern in clients with type 1 diabetes experiencing these symptoms.
C. Administering 1 ampule of 50% dextrose intravenously is an effective treatment for hypoglycemia but is typically reserved for severe cases where the patient is unable to consume oral glucose or is unconscious.
D. Administering 10 units of regular insulin subcutaneously would exacerbate the problem by lowering blood sugar further and is contraindicated in a patient experiencing hypoglycemic symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Confirming that the medication prescribed is the drug of choice for the specific microorganism is crucial in ensuring effective treatment, as the right drug will target the identified infection.
B. Teaching the client that significant adverse effects are expected and must be endured is not a supportive approach; the focus should be on managing and minimizing adverse effects rather than accepting them.
C. Administering antihistamines may not be relevant for all patients undergoing anti-infective treatment and is not a primary strategy for ensuring treatment success.
D. Monitoring for signs of arrhythmias or cardiac ischemia is not directly related to ensuring the success of anti-infective treatment; it may be necessary for certain medications but does not address the effectiveness of anti-infectives specifically.
Correct Answer is ["B","C","D"]
Explanation
A. Sit up comfortably in the bed is incorrect; the client should be in an upright position, which can be done while sitting up comfortably, but it’s essential to emphasize a more upright posture for optimal administration.
B. Tilt the head slightly to the side is correct; this position helps facilitate the delivery of the medication into the nasal passages.
C. Insert the tip of the nose piece into one nostril is correct; proper insertion ensures effective delivery of the medication.
D. Hold the breath for a few seconds after administering the spray is correct; this allows the medication to be absorbed more effectively.
E. Blow the nose 1 minute after administering the spray is incorrect; clients should avoid blowing their nose immediately after use to allow for proper absorption of the medication.
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