The birth weight of an infant delivered by a woman with gestational diabetes is 10.1 pounds (4,581 grams). The infant is jitery and has a heel stick glucose level of 40 mg/dL (2.2 mmol/L) 30 minutes after birth. Based on this information, which intervention should the practical nurse (PN) implement first?

Reference range:

Blood glucose neonate: [30 to 60 mg/dL or 1.7 to 3.3 mmol/L]

This client has the highest priority, as he or she may be experiencing an acute asthma attack that can compromise the airway and oxygenation. The PN should assess the client's respiratory status, administer bronchodilators, and monitor for improvement or deterioration.

B. A 7-year-old child who has type 1 diabetes mellitus and is experiencing extreme hunger and shakiness.

This client has the second highest priority, as he or she may be experiencing hypoglycemia, which is a low blood glucose level that can cause neurologic symptoms such as confusion, seizures, or coma. The PN should check the client's blood glucose level, provide a source of glucose, and monitor for recovery or complications.

C. A 10-year-old child with bleeding lacerations on both knees after falling on the playground.

This client has the third highest priority, as he or she may have a risk of infection or blood loss from the wounds. The PN should clean and dress the lacerations, apply pressure if needed, and check for signs of infection or inflammation.

D. A 5-year-old child who is crying uncontrollably because of an incontinent bowel episode.

This client has the lowest priority, as he or she does not have a life-threatening or urgent condition, but a psychosocial or emotional issue. The PN should provide comfort and reassurance to the child, change his or her clothes, and explore the possible causes of the incontinence.

A. Elevated energy level: While cocaine use can initially cause increased energy, this is a temporary effect. The most consistent and concerning behavioral manifestation is drug-seeking behavior due to intense cravings.
B. Powerful craving for more: Cocaine is highly addictive and stimulates the brain's reward system, leading to a powerful and often uncontrollable craving for more of the drug, which is a hallmark of cocaine dependence.
C. High self-esteem: Cocaine use may cause temporary grandiosity, but it does not result in true or stable high self-esteem. Users often experience mood swings and depressive symptoms after the drug wears off.
D. Euphoria: Cocaine does cause euphoria, but it is short-lived. The craving for more, even after the initial high, is more defining and persistent in clients who test positive and are in the cycle of use.