After a change-of-shift report, which client should the nurse assess first?

A 50-yr-old patient who uses exenatide (Byetta) and is complaining of acute abdominal pain

A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL

A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL

A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12%

Answer and Explanation

The Correct Answer is B

A blood glucose level of 40 mg/dL indicates severe hypoglycemia, which is a medical emergency requiring immediate attention. Hypoglycemia can lead to confusion, altered mental status, seizures, and loss of consciousness if not treated promptly. Therefore, it is crucial to assess and intervene quickly to raise the patient's blood glucose level to a safe range.

While the other clients mentioned also require attention and appropriate care, the severity and immediate risk associated with severe hypoglycemia make it the priority situation. The nurse should initiate appropriate treatment for hypoglycemia, such as administering glucose or glucagon, and closely monitor the patient's response.

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Correct Answer is D

Explanation

These symptoms suggest the possibility of deep vein thrombosis (DVT), which is a potentially serious complication following surgery. DVT occurs when a blood clot forms in a deep vein, commonly in the lower extremities. The symptoms of a swollen, warm, and painful calf can indicate the presence of a DVT.

DVT is a medical emergency that requires immediate attention and intervention to prevent further complications such as a pulmonary embolism (where the blood clot travels to the lungs). Prompt evaluation and treatment, such as anticoagulant therapy, are necessary to prevent complications

A. Signs and symptoms of hypoglycemia. B. Not to take this medication if they are having a procedure with contrast dye. C. To only take this medication if their blood glucose is over 250 mg/dL. D. To check their blood glucose after eating.

Correct Answer is A

Explanation

Glipizide is an oral antidiabetic medication commonly prescribed to manage type 2 diabetes. It works by stimulating the release of insulin from the pancreas, which helps lower blood glucose levels. However, there is a risk of hypoglycemia (low blood sugar) with the use of Glipizide.

It is crucial for the client to be aware of the signs and symptoms of hypoglycemia so that they can take appropriate action if their blood sugar drops too low. These symptoms may include sweating, trembling, dizziness, confusion, weakness, and hunger. By recognizing these signs, the client can promptly address hypoglycemia by consuming a source of fast-acting glucose, such as fruit juice or glucose tablets, as instructed by their healthcare provider.

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After a change-of-shift report, which client should the nurse assess first?

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