The practical nurse (PN) is caring for an adolescent with type 1 diabetes mellitus who presents with an HbA1c of 11% (97 mmol/mol), thirst, and blurred vision.
Which action should the PN take first?
Review prior insulin prescriptions.
Check blood pressure.
Obtain point-of-care glucose.
Assess urine for ketones.
The Correct Answer is C
The first action the PN should take is to obtain a point-of-care glucose test. This will provide immediate information about the patient's blood sugar level and help guide further interventions.
Option A, reviewing prior insulin prescriptions, is important but not the first priority.
Option B, checking blood pressure, is also important but not the most immediate concern.
Option D, assessing urine for ketones, can provide useful information about the presence of ketones in the urine, which can indicate diabetic ketoacidosis, but it is not the first action that should be taken.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The priority goal for the practical nurse (PN) in the antepartum clinic is to ensure that the client recognizes the dangers of alcohol use during pregnancy. Alcohol consumption during pregnancy can lead to fetal alcohol syndrome and other developmental disorders. It is important for the client to understand the risks associated with alcohol use and to avoid it during pregnancy. The other goals are also important but recognizing the dangers of alcohol use takes priority.
Correct Answer is C
Explanation
A positive indirect Coombs' test indicates that the mother has developed Rh antibodies against the baby's Rh-positive blood. This finding can result in hemolytic disease of the newborn, which is a condition in which the mother's Rh antibodies atack the baby's red blood cells, causing destruction and potential anemia.
The baby may require phototherapy for physiologic jaundice, but the Coombs' test result indicates a different issue.
The presence of an infectious blood-borne disease cannot be determined from this test.
The mother may still need Rho (D) immune globulin injections after delivery of an Rh-positive baby.
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