A 70-year-old female with type 2 diabetes is brought to the clinic by her daughter, who states that her mother has been more drowsy and irritable than usual.
This morning, she was found confused, diaphoretic, and unable to answer Questions clearly.
The patient has a history of poor oral intake over the past 2 days and is currently taking glipizide.
Vital signs show
- BP 130/82 mmHg
- HR 98 bpm
- RR 18 breaths/min
- Temp 97.8
- Blood glucose is 42 mg/dL
Based on these findings, which condition is the client most likely experiencing?
Hypoglycemia.
Diabetic Ketoacidosis (DKA).
Stroke.
Hyperosmolar Hyperglycemic State (HHS).
The Correct Answer is A
Choice A rationale
Hypoglycemia occurs when blood glucose levels fall below 70 mg/dL, and a level of 42 mg/dL is critically low. This client exhibits classic neuroglycopenic symptoms, including confusion, drowsiness, and irritability, alongside adrenergic signs like diaphoresis. Glipizide, a sulfonylurea, stimulates insulin secretion regardless of glucose levels, which often leads to prolonged hypoglycemia in patients with poor oral intake. Her age and reduced intake over two days significantly increased her risk for this specific metabolic crisis.
Choice B rationale
Diabetic ketoacidosis is characterized by extreme hyperglycemia, typically over 250 mg/dL, along with metabolic acidosis and ketone production. Patients usually present with Kussmaul respirations, a fruity breath odor, and dehydration. This patient’s blood glucose is 42 mg/dL, which is the opposite of the high levels seen in DKA. While confusion can occur in DKA due to acidosis, the low glucose reading and history of glipizide use point directly toward hypoglycemia rather than a state of insulin deficiency.
Choice C rationale
While confusion and irritability can be signs of a stroke, the rapid onset of symptoms in the presence of a known diabetic taking glipizide makes a metabolic cause more likely. Stroke symptoms are usually focal, such as one-sided weakness or facial drooping, which are not described here. Furthermore, the blood glucose reading of 42 mg/dL is an objective finding that explains her neurological status perfectly. It is standard practice to rule out hypoglycemia before diagnosing a stroke.
Choice D rationale
Hyperosmolar Hyperglycemic State is a complication of type 2 diabetes marked by severe hyperglycemia, often exceeding 600 mg/dL, and profound dehydration without significant ketosis. This client’s blood glucose of 42 mg/dL is far below the threshold for HHS. While HHS can cause altered mental status and confusion due to high serum osmolality, this patient’s presentation is dominated by the physiological effects of a sugar deficit, not the osmotic diuresis and high sugar levels characteristic of HHS.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Perioperative is a broad, umbrella term that encompasses the entire surgical experience, including the preoperative, intraoperative, and postoperative phases. While the task of reviewing lab work occurs within the perioperative period, it is not the most specific phase for this activity. Using this term does not help distinguish when the screening occurs. Professional nursing standards require more specific categorization of tasks to ensure that safety checks, like lab reviews, are completed before anesthesia.
Choice B rationale
The preoperative phase begins when the decision for surgery is made and ends when the patient is transferred to the operating room table. Reviewing surgical screening labs, such as hemoglobin, electrolytes, and coagulation studies, is a critical safety intervention during this phase. This ensures the client is physiologically stable and identifies potential risks, like anemia or hypokalemia, before the procedure begins. Normal potassium is 3.5 to 5.0 mEq/L and normal hemoglobin is 12 to 18 g/dL.
Choice C rationale
The intraoperative phase begins when the patient is transferred onto the operating room table and ends when they are admitted to the post-anesthesia care unit. During this time, the focus is on anesthesia maintenance, surgical site sterility, and physiological monitoring. While labs might be drawn during surgery in an emergency, the routine review of elective screening lab work must happen before this stage to prevent avoidable complications or the cancellation of the surgery after anesthesia induction.
Choice D rationale
The postoperative phase begins with the admission of the patient to the recovery area and continues until follow-up evaluation in the clinical setting or at home. Reviewing initial screening labs during this phase would be late and ineffective for preventing surgical complications. Postoperative lab reviews focus on assessing the impact of the surgery, such as blood loss or fluid shifts, rather than screening for elective readiness. This phase is for recovery, monitoring, and discharge planning.
Correct Answer is A
Explanation
Choice A rationale
Insulin glargine is classified as a long-acting basal insulin analogue designed to provide a steady level of insulin for an extended period. It typically has an onset of 1.1 hours, no pronounced peak, and a duration of action that lasts between 18 to 24 hours. This pharmacological profile mimics the continuous basal secretion of insulin by a healthy pancreas, which is essential for maintaining stable blood glucose levels between meals and during sleep.
Choice B rationale
A duration of 14 hours is generally associated with intermediate-acting insulins like NPH, which typically act for 12 to 18 hours, rather than long-acting glargine. Insulin glargine is specifically engineered with a low solubility at a neutral pH, allowing it to form micro-precipitates in the subcutaneous tissue that release slowly over a full day. A 14-hour window would result in a significant gap in basal coverage for a patient requiring 24-hour glycemic control.
Choice C rationale
A duration of 3 to 6 hours is characteristic of rapid-acting insulins such as lispro, aspart, or glulisine, which are used primarily to manage postprandial glucose spikes. These insulins have a quick onset of 15 minutes and peak within 1 to 2 hours. Using these as a reference for insulin glargine would be incorrect because glargine is meant for long-term stabilization rather than immediate mealtime coverage, and its action is significantly more prolonged.
Choice D rationale
A duration of 6 to 10 hours is most representative of short-acting regular insulin, which has a total duration of action typically spanning 5 to 7 or 8 hours. Regular insulin is used for bolus coverage during meals or in emergency intravenous scenarios. Glargine’s unique chemical structure ensures a much longer presence in the systemic circulation to maintain a flat, peakless effect, making the 6 to 10-hour timeframe inaccurate for this specific medication.
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