A client is brought to the emergency room unconscious, with a pulse, and with a blood glucose of 40. The client is wearing a Medic-Alert bracelet indicating that he has Type 1 diabetes mellitus.
What order should the nurse anticipate?
Give glucagon.
Give orange juice.
Perform CPR.
Give insulin.
The Correct Answer is A
Choice A rationale:
Glucagon directly addresses the underlying issue of severe hypoglycemia: In a patient with Type 1 diabetes mellitus, a blood glucose level of 40 mg/dL signifies a critical condition known as severe hypoglycemia. This condition occurs when blood sugar levels drop dangerously low, depriving the brain and other vital organs of glucose, their primary source of energy. Glucagon, a hormone that acts opposite to insulin, is the most effective and rapid treatment for severe hypoglycemia. It works by stimulating the liver to release stored glucose into the bloodstream, quickly raising blood sugar levels and restoring normal brain function.
Rationale for other choices:
Choice B: Give orange juice: While orange juice contains carbohydrates that can raise blood sugar, it is not ideal for treating severe hypoglycemia due to its slower absorption rate compared to glucagon. In an unconscious patient, there's also a risk of aspiration if given orally.
Choice C: Perform CPR: CPR is not indicated in this scenario as the patient has a pulse. CPR is a lifesaving technique that is only used when a person's heart has stopped beating.
Choice D: Give insulin: Insulin, which lowers blood glucose, would be contraindicated in this situation as the patient is already experiencing severe hypoglycemia. Administering insulin would further decrease blood sugar levels, worsening the patient's condition.
Key points to remember:
Severe hypoglycemia is a medical emergency that requires prompt treatment with glucagon.
Glucagon is the only medication that can effectively and quickly raise blood glucose levels in severe hypoglycemia. It's crucial to administer glucagon as soon as possible to prevent irreversible brain damage or even death.
Healthcare professionals should be proficient in recognizing the signs and symptoms of severe hypoglycemia and administering glucagon appropriately.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Amiodarone is an antiarrhythmic medication that is often used to treat ventricular tachycardia and ventricular fibrillation. However, it is not the first-line drug for Torsades de Pointes. In fact, amiodarone can actually worsen QT prolongation and increase the risk of Torsades de Pointes.
It's important to note that amiodarone has a long half-life and can accumulate in the body over time, further increasing the risk of QT prolongation.
Additionally, amiodarone can have several serious side effects, including pulmonary toxicity, thyroid dysfunction, and liver damage.
Choice B rationale:
Lidocaine is another antiarrhythmic medication that is sometimes used to treat ventricular arrhythmias. However, it is also not the first-line drug for Torsades de Pointes.
Lidocaine is less likely to worsen QT prolongation than amiodarone, but it can still have this effect in some patients.
Additionally, lidocaine has a short half-life and must be given as a continuous infusion, which can be challenging in a critical care setting.
Choice C rationale:
Atropine is a medication that is used to increase heart rate. It is not effective in treating Torsades de Pointes and is not indicated in this situation.
Atropine works by blocking the vagus nerve, which slows heart rate. In Torsades de Pointes, the heart rate is already very fast, so atropine would not be helpful.
Additionally, atropine can have several side effects, including dry mouth, blurred vision, and urinary retention.
Choice D rationale:
Magnesium sulfate is the first-line drug for treating Torsades de Pointes. It works by stabilizing the electrical activity of the heart and preventing further episodes of arrhythmia.
Magnesium sulfate is a relatively safe medication with few side effects. It can be given as an intravenous infusion or as an intramuscular injection.
Studies have shown that magnesium sulfate is effective in terminating Torsades de Pointes and preventing recurrences.
Correct Answer is B
Explanation
Choice A Rationale:
NPH insulin can be mixed with certain other insulins, such as regular insulin, to achieve different effects and better control blood glucose levels. Therefore, stating that it should never be mixed with another insulin is incorrect.
Choice C rationale:
NPH insulin is an intermediate-acting insulin that can be administered at various times of the day, depending on the individual's needs and blood glucose patterns. It is not restricted to bedtime administration only.
Choice D rationale:
When mixing NPH insulin with another insulin, the order of mixing does not significantly affect its action. The crucial aspect is to ensure proper mixing of the insulins before administration.
Choice B rationale:
NPH insulin is a suspension, meaning the insulin particles are not fully dissolved in the liquid. Therefore, it's essential to roll the vial gently between the palms to evenly distribute the insulin particles throughout the solution. This ensures that the patient receives the correct dose and prevents injection of an uneven mixture, which could lead to unpredictable blood glucose levels.
Key points to remember:
NPH insulin is an intermediate-acting insulin that starts working within 1 to 2 hours, peaks in 4 to 12 hours, and lasts for 12 to 18 hours.
It can be mixed with regular insulin to provide both short-acting and longer-acting insulin coverage. Always follow the specific instructions provided by the insulin manufacturer and healthcare provider. Proper mixing of NPH insulin is crucial for accurate dosing and optimal glucose control.
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