A nurse in a clinic is collecting data from an adolescent who has type 1 diabetes mellitus.Which of the following findings is the priority for the nurse to report?
Client's current blood glucose is 220 mg/dL
Client is exhibiting Kussmaul respirations
Client reports vomiting once that day
Client reports frequent urination
The Correct Answer is B
Choice A reason:
A blood glucose level of 220 mg/dL is elevated and should be addressed, but it may not be an immediate priority compared to the presence of Kussmaul respirations.
Choice B reason.
Correct. Kussmaul respirations are a sign of diabetic ketoacidosis (DKA), a severe complication of diabetes. This requires immediate attention and intervention.
Choice C reason:
Vomiting is a concerning symptom, but it may not be as immediately life-threatening as Kussmaul respirations.
Choice D reason:
Frequent urination is a common symptom of diabetes, but it may not require immediate intervention unless it is accompanied by other severe symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
- Choice A Rationale: Preschoolers may personify death as a character or monster due to their developmental stage and exposure to media, but this is not a universal belief and may not be helpful in a teaching context.
- Choice B Rationale: Preschoolers often conceptualize death as a reversible or temporary condition, similar to sleep, due to their limited understanding of the permanence of death, making this an appropriate statement for the nurse to include.
- Choice C Rationale: While preschoolers may express curiosity about death, their understanding is concrete and they may not grasp abstract concepts about what happens after death, thus this statement might not be entirely accurate for all preschoolers.
- Choice D Rationale: Preschoolers may have fears related to death, but these are more often related to separation from parents or changes in routine rather than physical changes during dying, which they may not fully comprehend.
Correct Answer is D
Explanation
Choice A reason:
A diet soft drink does not contain enough sugar to raise the child's blood glucose level quickly. It is not the appropriate choice in this situation.
Choice B reason:
Metformin is a medication used to manage type 2 diabetes, not type 1 diabetes. It would not be effective in treating the low blood sugar (hypoglycemia) in this scenario.
Choice C reason:
Administering insulin would further lower the child's blood glucose level and is contraindicated in cases of hypoglycemia.
Choice D reason:
This statement is correct. A regular soft drink contains sugar and can rapidly increase the child's blood glucose level, effectively treating the hypoglycemia.
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