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.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Prednisone is a corticosteroid medication that can increase blood glucose levels by promoting gluconeogenesis (the production of glucose from non-carbohydrate sources) and reducing glucose utilization in the body. This can lead to elevated blood sugar levels, especially in individuals with diabetes. The client's history of urinary tract infection and the use of Prednisone suggest that the infection might have triggered the development of DKA.

It's important to note that DKA can occur even when a person is taking insulin as prescribed and following their diet carefully if other factors contribute to the development of DKA, such as an underlying infection or the use of certain medications like Prednisone. The nurse should further assess the client's condition and notify the healthcare provider to initiate appropriate management for DKA.

Correct Answer is ["250"]

Explanation

To calculate the rate at which the nurse should set the IV pump in mL/hr, we need to determine the infusion rate.

The client is receiving 1 gram of antibiotic in 500 ml of fluid over 2 hours. To find the rate in mL/hr, we divide the total volume (500 ml) by the total time (2 hours):

Rate = Volume / Time Rate = 500 ml / 2 hours Rate = 250 ml/hr

Therefore, the nurse should set the IV pump at a rate of 250 mL/hr.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is admitted with Diabetic Ketoacidosis (DKA). The client asks the nurse "Why did this happen? I have been taking my insulin as prescribed and following my diet carefully" The nurse reviews the client's chart and realizes that this emergency may be related to which common causes of DKA?

Correct Answer is C

Explanation

The client is to receive an antibiotic 1 gram in 500 ml of fluid intravenously over 2 hours. At what rate will the nurse set the IV pump in mL/hr.? (Answer as whole number)

Correct Answer is ["250"]

Explanation

The nurse is caring for a patient who had abdominal surgery yesterday and is receiving morphine through patient controlled analgesia (PCA). What action by the nurse is a priority?

The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I don't understand what the doctor said about the surgery." Which action should the nurse take next?

The nurse is administering nitroprusside by IV infusion for a client in hypertensive emergency. The nurse knows that the primary assessment will be:

A patient is receiving Gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition?

Which assessment finding is the best Indicator to the nurse that a client's peristaltic activity (Gl motility) has resumed after surgery?

Heparin 7,000 units is ordered. Heparin 5,000 units per ml is available. How many milliliters (ml) should the nurse administer? (Do not round)

The nurse is admitting a client diagnosed with acute renal failure (ARF). The nursing assessment will prioritize ...