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 ["A","C"]
Explanation
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin analog that is designed to provide a steady, basal level of insulin throughout the day.
It has a duration of action of approximately 24 hours, so it is typically administered once daily at bedtime.
This helps to control blood glucose levels overnight and during the early morning hours, when the risk of hypoglycemia is highest.
Key characteristics of Insulin Glargine (Lantus):
Onset: 1-2 hours
Peak: No pronounced peak Duration: Approximately 24 hours
Administration: Once daily at bedtime
Choice B rationale:
Lispro (Humalog) is a rapid-acting insulin analog that is designed to be taken with meals to help control blood glucose spikes after eating.
It has a onset of action of approximately 15 minutes and a duration of action of 2-4 hours.
Because of its rapid onset and short duration of action, lispro is not typically used as a basal insulin. Key characteristics of Lispro (Humalog):
Onset: 15 minutes
Peak: 30-90 minutes
Duration: 2-4 hours
Administration: With meals
Choice C rationale:
Insulin detemir (Levemir) is another long-acting insulin analog that is similar to insulin glargine in terms of its duration of action.
It is typically administered once daily at bedtime to provide basal insulin coverage. Key characteristics of Insulin Detemir (Levemir):
Onset: 1-2 hours
Peak: No pronounced peak
Duration: Approximately 18-24 hours Administration: Once daily at bedtime Question 23.
The nurse receives an order for insulin: NPH (Humulin NPH) 10 units to be administered intravenously daily at 7:00am.
What action should the nurse take?
A. Administer the dose but ensure that if mixed with another Humulin-R insulin, to draw the regular insulin up first.
B. Give the drug subcutaneously rather than IV
C. Review the insulin order with the prescriber and pharmacy.
D. Administer the insulin ordered mixed in 50 ML of 0.9%NS IV Piggyback (not to infuse faster than 1/2 hour or 30 minutes).
The correct answer is C. Review the insulin order with the prescriber and pharmacy.
Rationale for Choice A:
Intravenous administration of NPH insulin is not recommended. It is an intermediate-acting insulin that is designed to be absorbed slowly from the subcutaneous tissue. IV administration can lead to rapid and unpredictable changes in blood glucose levels, which can be dangerous.
Mixing NPH insulin with regular insulin does not change the route of administration. Both insulins should still be given subcutaneously.
Rationale for Choice B:
Subcutaneous administration of NPH insulin is the correct route. This allows for slow and steady absorption of the insulin, which helps to prevent blood glucose fluctuations.
However, the nurse should still clarify the order with the prescriber and pharmacy. This is because IV insulin orders are unusual and may be a mistake.
Rationale for Choice D:
Adding NPH insulin to a 50 mL IV piggyback is not a safe practice. This would dilute the insulin and make it even more difficult to control the rate of infusion.
IV insulin infusions are typically administered using a dedicated insulin pump. This allows for precise control of the infusion rate and helps to prevent hypoglycemia.
Rationale for Choice C:
Reviewing the insulin order with the prescriber and pharmacy is the safest course of action. This will help to ensure that the order is correct and that the insulin is administered safely.
The prescriber may have meant to order regular insulin instead of NPH insulin. Regular insulin can be given intravenously, but it requires careful monitoring of blood glucose levels.
The pharmacy can also double-check the order and ensure that the correct insulin is dispensed.
Correct Answer is D
Explanation
Choice A rationale:
Adenosine is a medication used to treat supraventricular tachycardia (SVT), a type of rapid heart rhythm that originates in the upper chambers of the heart. It works by slowing the conduction of electrical impulses through the heart's AV node.
In this patient, the heart rate is already slow (42 beats per minute), so adenosine would not be appropriate. It could further slow the heart rate and potentially cause a dangerous drop in blood pressure.
Choice B rationale:
Amiodarone is a medication used to treat a variety of heart rhythm problems, including ventricular tachycardia (VT) and ventricular fibrillation (VF). It works by slowing the conduction of electrical impulses through the heart muscle.
Amiodarone is not typically used as a first-line treatment for bradycardia (slow heart rate). It is usually reserved for more serious or life-threatening arrhythmias.
Choice C rationale:
Magnesium sulfate is a medication used to treat a variety of conditions, including preeclampsia, eclampsia, and torsades de pointes. It can also be used to treat certain types of arrhythmias.
Magnesium sulfate is not typically used as a first-line treatment for bradycardia. It may be used in some cases of bradycardia caused by electrolyte imbalances or certain medications.
Choice D rationale:
Atropine sulfate is a medication that blocks the action of acetylcholine, a neurotransmitter that slows the heart rate. It is the first-line treatment for symptomatic bradycardia.
Atropine works by increasing the heart rate and improving conduction through the AV node. It is a rapid-acting medication that can be given intravenously, intramuscularly, or subcutaneously.
In this patient, atropine sulfate would be the most appropriate medication to increase the heart rate and improve blood pressure.
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