A nurse is reinforcing teaching about manifestations of hypoglycemia with an adolescent who has type 1 diabetes mellitus. Which of the following manifestations should the nurse include in the teaching?
Diminished reflexes
Rapid respirations
Acetone breath
Headache
The Correct Answer is D
A. Diminished reflexes:
Explanation: Diminished reflexes are not typically associated with hypoglycemia. Instead, hypoglycemia may cause hyperactive reflexes or tremors.
B. Rapid respirations:
Explanation: Rapid respirations are not a common manifestation of hypoglycemia. In hypoglycemia, the body might respond with shallow, rapid breathing or hyperventilation.
C. Acetone breath:
Explanation: Acetone breath, often described as fruity or sweet, is associated with diabetic ketoacidosis (DKA), which is a complication of hyperglycemia rather than hypoglycemia.
D. Headache:
Explanation: Headache is a common manifestation of hypoglycemia. It can occur as a result of decreased glucose levels affecting the brain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Iron:
Function: Iron is essential for the formation of hemoglobin, a protein in red blood cells that carries oxygen from the lungs to the rest of the body. It is vital for oxygen transport and overall cellular function.
Relevance: Iron deficiency can lead to anemia, characterized by reduced oxygen-carrying capacity of the blood, resulting in fatigue, weakness, and other symptoms.
B. Magnesium:
Function: Magnesium is involved in various cellular processes, including muscle and nerve function, blood glucose control, and bone health.
Relevance: While magnesium has important functions in the body, it is not directly involved in the transport of oxygen like iron.
C. Phosphorus:
Function: Phosphorus is a key component of DNA, RNA, and ATP, playing a role in energy metabolism, bone health, and acid-base balance.
Relevance: While important for cellular processes, phosphorus is not specifically linked to the transport of oxygen.
D. Potassium:
Function: Potassium is crucial for maintaining proper fluid balance, nerve impulses, and muscle contractions.
Relevance: Potassium is not directly involved in the transport of oxygen; its primary functions are related to electrolyte balance and cellular activities.
Correct Answer is A
Explanation
A. Identify the clients at greatest risk for the development of pressure ulcers.
This option emphasizes the importance of individualized care. By identifying clients at the highest risk for pressure ulcers, healthcare providers can tailor preventive measures to address specific risk factors such as immobility, nutritional deficits, and skin conditions.
B. Turn and position each client every 2 hr.
Regular turning and repositioning are crucial in preventing pressure ulcers, especially in individuals with limited mobility. This helps distribute pressure, reducing the risk of skin breakdown. However, this alone may not be sufficient if other risk factors are not addressed.
C. Use a barrier cream when performing perineal care.
Barrier creams can be helpful in protecting the skin from moisture and friction, especially in areas prone to pressure ulcers. While this is a good practice, it may not be the top priority compared to identifying those at the highest risk.
D. Supervise clients to ensure adequate nutritional intake.
Proper nutrition plays a vital role in maintaining skin integrity. Malnutrition can contribute to the development of pressure ulcers. Monitoring and ensuring adequate nutritional intake are important components of prevention but may not be the initial priority.
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