A nurse is caring for a group of clients. Which of the following clients should the nurse attend to first?

An older adult client who is anxious and attempting to pull out an IV line

A middle adult client who is reporting nausea after receiving pain medication

An older adult client who has kidney failure and returned from dialysis 4 hr ago

A middle adult client who has a terminal illness and is requesting a visit from the chaplain

Answer and Explanation

The Correct Answer is A

- A. This client is at risk of harming themselves by removing the IV line, which could cause bleeding, infection, or loss of medication. This is a priority issue that requires immediate intervention by the nurse.

- B. This client is experiencing a common side effect of pain medication, which can be managed by administering antiemetics, fluids, or changing the medication. This is not a life-threatening issue and can be addressed after attending to the client in choice A.

- C. This client has a chronic condition that requires regular dialysis, but they are not in acute distress at this time. They should be monitored for signs of fluid overload, electrolyte imbalance, or infection, but they are not a priority over the client in choice A.

- D. This client has a psychosocial need that should be respected and supported by the nurse, but it is not an urgent issue that requires immediate attention. The nurse can arrange for a visit from the chaplain after attending to the client in choice A.

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Correct Answer is C

Explanation

Choice A rationale:

A random plasma glucose level of 176 mg/dL indicates high blood sugar at the time of the test. Random glucose levels are not ideal for assessing glycemic control as they can vary based on recent food intake and stressors.

Choice B rationale:

Triglyceride levels are not used to assess glycemic control. They measure the amount of triglycerides in the bloodstream and are related to lipid metabolism, not glucose control.

Choice C rationale:

HbA1c (glycated hemoglobin) is a long-term measure of blood glucose control. An HbA1c level of 6.8% indicates acceptable glycemic control in a person with diabetes. The normal range for HbA1c is typically less than 6.5%. This test reflects the average blood sugar level over the past 2-3 months, giving a better understanding of overall glucose control.

Choice D rationale:

Fasting blood glucose of 120 mg/dL is slightly elevated. While fasting blood glucose levels below 100 mg/dL are generally considered normal, levels between 100-125 mg/dL are considered prediabetic, and levels above 126 mg/dL on two separate occasions indicate diabetes. The result provided falls within the prediabetic range but does not indicate optimal glycemic control.

A. Encourage the client to take a cool sponge bath each morning. B. Administer opioid analgesia. C. Increase the client's dietary iron intake. D. Restrict the client's intake of foods high in purines.

Correct Answer is C

Explanation

- A. Encourage the client to take a cool sponge bath each morning is not correct because it can increase joint stiffness and pain.

- B. Administer opioid analgesia is not correct because it is not the first-line treatment for rheumatoid arthritis and can cause dependence and tolerance.

- C. Increase the client's dietary iron intake is indicate in rheumatoid arthritis due to anemia of chronic inflammation.

- D. Restrict the client's intake of foods high in purines is incorrect in rheumatoid. It is an important measure in gouty arthritis.

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A nurse is caring for a group of clients. Which of the following clients should the nurse attend to first?

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