The nurse is caring for a female client with type 2 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:
15 to 20 g of a fast-acting carbohydrate such as orange juice.
I.V. bolus of dextrose 50%.
I.M. or subcutaneous glucagon.
10 U of fast-acting insulin
The Correct Answer is C
A. 15 to 20 g of a fast-acting carbohydrate such as orange juice:
This is a standard and initial treatment for hypoglycemia. Fast-acting carbohydrates, like orange juice or glucose tablets, can quickly raise blood sugar levels. However, in the scenario described, the client is still conscious, and glucagon may be a more appropriate choice.
B. I.V. bolus of dextrose 50%:
Intravenous (IV) dextrose is a more aggressive intervention and is typically reserved for severe cases of hypoglycemia or for unconscious patients. It is not the first-line treatment for conscious patients.
C. I.M. or subcutaneous glucagon:
Glucagon is a hormone that raises blood sugar levels by promoting the conversion of stored glycogen in the liver to glucose. It is administered either intramuscularly (I.M.) or subcutaneously. In a conscious patient with hypoglycemia who cannot take oral carbohydrates, glucagon can be an effective and rapid way to raise blood sugar levels.
D. 10 U of fast-acting insulin:
Administering more insulin in a situation of hypoglycemia would worsen the condition. The goal in hypoglycemia is to raise blood sugar, and giving more insulin would have the opposite effect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "The parathyroid has no effect on calcium levels in the body; this will just help prevent osteoporosis":
Explanation: This statement is incorrect. The parathyroid gland plays a crucial role in calcium homeostasis. Hypoparathyroidism, characterized by decreased parathyroid hormone (PTH) production, leads to low blood calcium levels, not high levels.
B. "The reason you have hypoparathyroidism is that you were diagnosed with hypothyroidism, and when the thyroid doesn't work, neither does the parathyroid, so you need these supplements."
Explanation: This statement is incorrect. The parathyroid and thyroid are separate glands with distinct functions. Hypoparathyroidism is not a result of hypothyroidism.
C. "A decrease in parathyroid hormone causes low calcium levels, so your body to break down bones to maintain normal calcium levels, and this will prevent that from happening."
Explanation: This is the correct statement. Hypoparathyroidism leads to a decrease in PTH, resulting in low blood calcium levels. Without sufficient PTH, the body may resort to breaking down bones to maintain calcium levels.
D. "An increase in parathyroid hormone causes your body to move calcium into the cells to reduce blood calcium levels, so you have to replace the levels in the blood."
Explanation: This statement is incorrect. An increase in parathyroid hormone (PTH) typically leads to increased blood calcium levels by promoting the release of calcium from bones and reducing calcium excretion by the kidneys. This describes hyperparathyroidism, not hypoparathyroidism.
Correct Answer is D
Explanation
A. Flushed skin: Flushed or warm skin is more characteristic of hyperthyroidism, where there is an excess of thyroid hormones.
B. Palpitations: Palpitations or a rapid heartbeat are more characteristic of hyperthyroidism, where there is an excess of thyroid hormones.
C. Bulging eyes: Bulging or protruding eyes, known as exophthalmos, is a characteristic sign of Graves' disease, which is a specific type of hyperthyroidism.
D. Fatigue: This is correct. Fatigue is a common symptom of hypothyroidism, reflecting the overall slowing down of the body's processes.
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