A nurse is caring for a client who has type 1 diabetes mellitus. The client reports that she is not feeling well. Which of the following findings should indicate to the nurse that the client is hypoglycemic? (Select all that apply.)

Acetone breath odor

Polydipsia

Inability to concentrate

Diaphoresis

Tremors

Answer and Explanation

Correct Answer : C,D,E

Rationale:
A. Acetone breath odor: A fruity or acetone breath odor occurs when the body produces ketones due to fat breakdown in hyperglycemia or diabetic ketoacidosis (DKA). This finding is not associated with hypoglycemia but rather prolonged high blood glucose levels.

B. Polydipsia: Excessive thirst (polydipsia) is a sign of hyperglycemia because the kidneys attempt to excrete excess glucose, leading to dehydration. It does not occur during hypoglycemia, when blood sugar levels are abnormally low.

C. Inability to concentrate: Low blood glucose deprives the brain of its primary energy source, leading to confusion, irritability, and difficulty concentrating. These neuroglycopenic symptoms are hallmark signs of hypoglycemia and can progress to altered consciousness if untreated.

D. Diaphoresis: Sweating is a classic adrenergic response to hypoglycemia as the body releases epinephrine to raise blood glucose levels. It serves as an early warning sign, prompting immediate carbohydrate intake to prevent further decline in blood sugar.

E. Tremors: Tremors occur due to increased sympathetic nervous system activity during hypoglycemia. The body responds to falling glucose by releasing catecholamines, which stimulate muscle activity and cause shaking or trembling sensations.

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Correct Answer is A

Explanation

Rationale:
A. "Avoid consuming grapefruit juice while taking this medication.": Grapefruit juice inhibits the cytochrome P450 enzyme system in the liver, leading to increased serum levels of nifedipine. This can potentiate adverse effects such as hypotension, dizziness, and tachycardia.

B. "Your magnesium level will be monitored while taking this medication.": Nifedipine, a calcium channel blocker, does not significantly affect magnesium levels. Monitoring magnesium is more relevant for clients receiving magnesium sulfate.

C. "This medication can cause changes in thyroid function.": Nifedipine has no known effects on thyroid hormones or gland function. Drugs affecting thyroid function include amiodarone or lithium, not calcium channel blockers like nifedipine.

D. "This medication can cause an increase in blood glucose levels.": Nifedipine does not alter glucose metabolism. Medications such as corticosteroids and thiazide diuretics are more likely to cause hyperglycemia, whereas nifedipine’s primary effects involve smooth muscle relaxation and vasodilation.

A. The person holding financial power of attorney will make health care decisions based on the client's advance directives. B. The client has the right to refuse medical treatment, even if health care providers recommend it. C. If the client's advance directives are in writing and notarized, the client cannot change it in the future. D. The client's eldest adult child has the right to change advance directives in an end-of-life situation.

Correct Answer is B

Explanation

Rationale:
A. A financial power of attorney manages financial affairs, not medical decisions. Health care decisions are instead guided by a health care proxy or durable power of attorney for health care, as outlined in the client’s advance directives.

B. The Patient Self-Determination Act upholds the client’s autonomy by allowing them to accept or refuse medical or life-sustaining treatment. This includes the right to decline care, even if such refusal may lead to death, ensuring that personal values and wishes guide end-of-life care.

C. Advance directives can be revised or revoked by the client at any time, regardless of notarization, as long as the client remains mentally competent. The document reflects current wishes and is not legally binding indefinitely.

D. Family members cannot alter a legally valid advance directive. The document represents the client’s own decisions, and only the client can modify or revoke it while competent to do so.

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A nurse is caring for a client who has type 1 diabetes mellitus. The client reports that she is not feeling well. Which of the following findings should indicate to the nurse that the client is hypoglycemic? (Select all that apply.)

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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