A nurse is caring for a client who has type 1 diabetes mellitus. Which of following actions should the nurse take first when providing morning cara?

Provide the client's breakfast.

Obtain the client's capillary blood glucose level.

Check the calibration of the glucometer.

Administer prescribed insulin.

Answer and Explanation

The Correct Answer is C

A. Providing the client's breakfast is an essential aspect of diabetes care, but obtaining information about the client's blood glucose level is a priority before administering insulin or making decisions about meal planning.

B. Obtaining the client's capillary blood glucose level is a critical first step. Knowing the current blood glucose level guides the nurse in determining the appropriate insulin dosage, assessing the need for any adjustments in the treatment plan, and planning the client's breakfast based on their current glucose level.

C. Checking the calibration of the glucometer is the first action to ensure the accuracy of the blood glucose measurement. Regular calibration checks help maintain the precision of the glucometer and ensure reliable results.

D. Administering prescribed insulin is an important step in managing type 1 diabetes, but the dosage should be determined based on the client's current blood glucose level. Administering insulin without knowing the current glucose level could lead to inappropriate dosage and potential complications.

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Correct Answer is C

Explanation

A.Notifying the charge nurse is an important action, as it ensures that other team members are aware of the error and can support corrective actions. However, this is not the first action the nurse should take, as assessing the client’s condition takes priority.

B.Informing the provider about the error is essential to allow for any additional orders or corrective measures, such as treatments to mitigate adverse effects. However, the nurse should first assess the client for any changes in condition to report specific findings to the provider if an intervention is needed.

C.Assessing the client’s condition is the first priority when a medication error is discovered. This action helps determine whether the incorrect dose has affected the client, allowing the nurse to provide immediate care if needed.

D.Completing an incident report is necessary to document the error, allowing the facility to review and address any procedural gaps. However, completing the report is not an immediate action in terms of client safety and should occur after assessing the client and notifying the necessary parties.

A. Reposition the client by log-rolling. B. Place a pillow under the client's back while supine. C. Remove the back brace when the client is out of bed. D. Maintain the head of the bed at 90°.

Correct Answer is A

Explanation

A. Repositioning the client by log-rolling is a critical intervention after lumbar laminectomy surgery. Log-rolling involves turning the entire body as a unit to prevent twisting or bending at the waist, which can strain the surgical site and potentially cause injury. This method helps protect the spine and maintain alignment during movement.

B. Placing a pillow under the client's back while supine is generally not recommended after a lumbar laminectomy. It may cause hyperextension of the spine, leading to discomfort and potential strain on the surgical site.

C. Removing the back brace when the client is out of bed is not a standard practice without specific orders from the surgeon. Back braces are often prescribed for support and stabilization during movement, especially in the early postoperative period.

D. Maintaining the head of the bed at 90° is not advisable after a lumbar laminectomy. The positioning of the bed should be individualized based on the surgeon's preferences, but typically, keeping the bed flat or in a slightly elevated position is more appropriate to reduce strain on the surgical site.

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A nurse is caring for a client who has type 1 diabetes mellitus. Which of following actions should the nurse take first when providing morning cara?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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