A nurse is assessing a client who has diabetes mellitus and reports feeling dizzy and weak. Which of the following actions should the nurse take?
Check blood glucose level.
Give insulin injection.
Offer orange juice.
Apply cold compress.
The Correct Answer is A
Choice A reason: Checking blood glucose level is an appropriate action for the nurse to take because it can help determine if the client has hypoglycemia or hyperglycemia, which are both complications of diabetes mellitus that can cause dizziness and weakness. Blood glucose level should be checked using a glucometer and compared with the normal range of 70 to 130 mg/dL before meals and less than 180 mg/dL after meals.
Choice B reason: Giving insulin injection is not an appropriate action for the nurse to take without checking blood glucose level first because it may cause hypoglycemia, which is a condition in which blood glucose level drops below 70 mg/dL and can cause dizziness, weakness, confusion, sweating, and seizures. Insulin injection should be given according to the prescribed dose, type, and schedule.
Choice C reason: Offering orange juice is not an appropriate action for the nurse to take without checking blood glucose level first because it may cause hyperglycemia, which is a condition in which blood glucose level rises above 180 mg/dL and can cause dizziness, weakness, thirst, polyuria, and ketoacidosis. Orange juice should be offered only if the client has hypoglycemia and is conscious and able to swallow.
Choice D reason: Applying cold compress is not an appropriate action for the nurse to take because it does not address the underlying cause of dizziness and weakness in a client who has diabetes mellitus. Cold compress may worsen the symptoms by reducing blood flow and oxygen delivery to the brain. Cold compress should be applied only if the client has fever, inflammation, or pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Tuna can is not a safe food choice for a client who has food allergies because it may contain traces of other fish or shellfish that can trigger an allergic reaction. Tuna can should be avoided or checked for allergen labels before consuming.
Choice B reason: Gravy beef is not a safe food choice for a client who has food allergies because it may contain gluten, soy, or dairy products that can trigger an allergic reaction. Gravy beef should be avoided or checked for allergen labels before consuming.
Choice C reason: Apple pie is a safe food choice for a client who has food allergies because it is unlikely to contain common allergens, such as nuts, eggs, or milk. Apple pie is made from cooked apples, sugar, flour, and butter, which are low-risk ingredients for food allergies. Apple pie should be stored in the refrigerator or freezer after cooling to prevent spoilage.
Choice D reason: Bread is not a safe food choice for a client who has food allergies because it may contain gluten, wheat, or sesame seeds that can trigger an allergic reaction. Bread should be avoided or checked for allergen labels before consuming.
Correct Answer is C
Explanation
Choice A reason: Eating more tuna is not an appropriate food choice for a client who has gout because it is high in purines, which are substances that break down into uric acid in the body. Uric acid can form crystals in the joints and cause inflammation and pain, which are symptoms of gout. Tuna should be limited or avoided by clients who have gout.
Choice B reason: Eating more red meat is not an appropriate food choice for a client who has gout because it is high in purines, which are substances that break down into uric acid in the body. Uric acid can form crystals in the joints and cause inflammation and pain, which are symptoms of gout. Red meat should be limited or avoided by clients who have gout.
Choice C reason: Eating blueberries every morning is an appropriate food choice for a client who has gout because they are low in purines and high in antioxidants, which are substances that protect the cells from damage caused by free radicals. Antioxidants can help reduce inflammation and pain, which are symptoms of gout. Blueberries also provide vitamin C, fiber, and water for the client.
Choice D reason: Eating bananas for a snack is not an appropriate food choice for a client who has gout because they are high in fructose, which is a type of sugar that can increase uric acid levels in the blood. Fructose can worsen gout attacks by triggering inflammation and pain in the joints. Bananas should be limited or avoided by clients who have gout.
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