The nurse is caring for a client with a blood glucose reading of 620 mg/dL. The nurse would expect all of the following interventions except which?
Antihypertensive medication
Fluid replacement
Potassium laboratory monitoring
Insulin IV infusion
The Correct Answer is A
A. Antihypertensive medication is not a priority intervention for a client with a blood glucose level of 620 mg/dL, which indicates hyperglycemia, likely due to diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). The focus should be on correcting the hyperglycemia and preventing complications like dehydration or electrolyte imbalances.
B. Fluid replacement is essential to treat dehydration caused by hyperglycemia, as high blood glucose levels cause osmotic diuresis.
C. Potassium laboratory monitoring is crucial because insulin treatment can shift potassium into cells, potentially causing hypokalemia, so monitoring is necessary during treatment.
D. Insulin IV infusion is necessary to lower the blood glucose level in clients with severe hyperglycemia, such as in DKA or HHS.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["75"]
Explanation
- Total volume: 1800 mL
- Infusion time: 24 hours
- Calculation: 1800 mL / 24 hours = 75 mL/hour
Therefore, the IV pump should be set to deliver 75 mL/hr.
Correct Answer is A
Explanation
A. A potassium level of 3.3 mEq/L indicates hypokalemia, which can lead to cardiac dysrhythmias due to the role of potassium in maintaining normal cardiac conduction and muscle contraction. Monitoring the client’s heart rhythm is crucial.
B. Neurogenic shock is not a complication of hypokalemia. It is typically caused by spinal cord injury or central nervous system damage, not electrolyte imbalances.
C. Hypoglycemia is not directly associated with hypokalemia or furosemide use. Furosemide primarily affects fluid and electrolyte balance, not glucose regulation.
D. While severe hypokalemia can cause neuromuscular issues, seizures are more commonly associated with conditions like hyponatremia or hypocalcemia, not hypokalemia.
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