A client tells the nurse about experiencing symptoms of a hypoglycemic insulin reaction. Which action should the nurse take FIRST?
Give the client juice or hard candy immediately.
Call the health care provider.
Have the client lie down and see if symptoms subside.
Assess the blood glucose level, and administer glucose in the most appropriate form.
The Correct Answer is D
A. Give the client juice or hard candy immediately: While giving juice or hard candy is an appropriate treatment for hypoglycemia, assessing the blood glucose level first is crucial to confirm that the symptoms are indeed due to low blood sugar.
B. Call the health care provider: While it's important to notify the healthcare provider if the situation worsens or if there's a concern about the client's safety, the first priority is to assess the blood glucose level and take immediate action to treat the hypoglycemia.
C. Have the client lie down and see if symptoms subside: Lying down does not address the underlying cause of hypoglycemia. The client may need glucose to raise their blood sugar levels, so this is not the most effective first action.
D. Assess the blood glucose level, and administer glucose in the most appropriate form: Assessing the blood glucose level will confirm whether the symptoms are indeed due to hypoglycemia, and then the nurse can proceed with administering glucose in the most appropriate form (such as oral glucose, juice, or glucose tablets).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Hypothyroidism: Hypothyroidism is characterized by symptoms such as weight gain, fatigue, dry skin, and cold intolerance. The teen's symptoms of weight loss, nervousness, and bulging eyes are not typical of hypothyroidism.
B. Juvenile autoimmune thyroiditis: Juvenile autoimmune thyroiditis is typically associated with hypothyroidism and does not present with symptoms like weight loss, nervousness, or bulging eyes. It is more often characterized by fatigue, cold intolerance, and weight gain.
C. Hashimoto thyroid disease: Hashimoto's disease is an autoimmune disorder that often leads to hypothyroidism. The symptoms described (weight loss, nervousness, bulging eyes) do not align with Hashimoto's disease, which is generally linked to an underactive thyroid.
D. Graves' Disease: Graves' disease is a type of hyperthyroidism often characterized by weight loss, nervousness, bulging eyes (exophthalmos). The symptoms align with the presentation of this teen, and the low TSH level further supports the diagnosis.
Correct Answer is B
Explanation
A. Regular: Regular insulin is a short-acting insulin, typically used for mealtime glucose control. It has a short duration of action (4-6 hours) and is not considered long-lasting insulin.
B. Insulin glargine (Lantus): Insulin glargine (Lantus) is a long-acting insulin that provides a steady release of insulin over a 24-hour period, without a peak, making it ideal for basal insulin coverage. It is designed to maintain blood glucose levels consistently throughout the day and night.
C. Insulin aspart (NovoLog): Insulin aspart is a rapid-acting insulin used primarily for mealtime glucose control, and it has a short duration of action, usually around 2-4 hours.
D. Insulin lispro (Humalog): Insulin lispro is a rapid-acting insulin that works quickly to control post-meal blood sugar but is not long-lasting. It typically lasts for about 3-5 hours.
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