A Type 1 diabetic client’s blood glucose level is 50 mg/dL at 16:30. The client is alert; however, dinner will not be served until 17:15. What should be the nurse’s initial action?

Have the client drink 4 oz. of orange juice

Give the client 3 tbsp.

of sugar dissolved in 4 oz. of grape juice to drink

Monitor the client closely until dinner arrives

Answer and Explanation

The Correct Answer is A

Step 1 is to understand that a blood glucose level of 50 mg/dL is considered hypoglycemic. Immediate treatment is necessary to raise the blood glucose level.

Step 2 is to follow the 15-15 rule for treating hypoglycemia, which recommends consuming 15 grams of carbohydrates and then checking blood glucose levels after 15 minutes. Four ounces of orange juice contains about 15 grams of carbohydrates and can quickly raise blood glucose levels.

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Correct Answer is C

Explanation

Choice A rationale

Monitoring the peak level of the antibiotic is important, but it is not the priority nursing action. Peak levels are typically drawn after the drug has been administered and are used to assess whether the dosage is sufficient.

Choice B rationale

Assessing the client’s vital signs is an important part of nursing care, but it is not the priority action when preparing to administer an aminoglycoside antibiotic.

Choice C rationale

Obtaining a serum trough level is the priority nursing action. Trough levels are drawn just before the next dose of the drug is due and are used to assess whether the dosage is safe.

Choice D rationale

Asking the client about drug allergies is an important part of nursing care, but it is not the priority action when preparing to administer an aminoglycoside antibiotic.

A. 08:30 B. 10:30 C. 14:30 D. 23:00 .

Correct Answer is C

No explanation

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A Type 1 diabetic client’s blood glucose level is 50 mg/dL at 16:30. The client is alert; however, dinner will not be served until 17:15. What should be the nurse’s initial action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing to administer an aminoglycoside antibiotic to a client admitted with a diagnosis of acute diverticulitis. What is the priority nursing action?

Correct Answer is C

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

A patient receives 20 units of Isophane Insulin Suspension (NPH) Insulin at 07:30. At what time are signs of hypoglycemia most likely to occur?

Correct Answer is C

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