A nurse in an emergency department is caring for an older adult client who has diabetes mellitus and is in a hyperglycemic-hyperosmolar state. Which of the following actions should the nurse take first?

Evaluate the client's understanding of diabetes management.

Administer potassium supplements.

Initiate a continuous infusion of 0.9% sodium chloride.

Chek for improvements in the client's level of consciousness.

Answer and Explanation

The Correct Answer is C

A) Evaluate the client's understanding of diabetes management: While it is important to assess the client’s understanding of diabetes management to prevent future hyperglycemic episodes, this is not the immediate priority. The client's current hyperglycemic-hyperosmolar state needs urgent intervention to stabilize their condition before educational measures can be effective.

B) Administer potassium supplements: Potassium supplementation may be necessary, especially if the client is hypokalemic, but it is not the first action. Electrolyte levels should be monitored and corrected as part of the treatment, but the initial priority is to address the severe dehydration and hyperglycemia.

C) Initiate a continuous infusion of 0.9% sodium chloride: This is the most critical first step. Clients in a hyperglycemic-hyperosmolar state are typically severely dehydrated due to osmotic diuresis. Initiating a continuous infusion of isotonic saline helps to restore intravascular volume, improve perfusion, and stabilize hemodynamics, which is essential before addressing other issues.

D) Check for improvements in the client's level of consciousness: Monitoring the client's level of consciousness is important as it provides information about their neurological status and response to treatment. However, this is a subsequent action after initiating fluid resuscitation, which directly addresses the immediate life-threatening aspects of the hyperglycemic-hyperosmolar state.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A) "I can add lean turkey to a salad.": Lean turkey is a good source of heme iron, which is more easily absorbed by the body compared to non-heme iron found in plant-based sources. Including iron-rich foods like lean turkey in the diet helps address iron-deficiency anemia effectively.

B) "I should choose apples over strawberries.": Apples are not particularly high in iron compared to strawberries. While apples provide some nutrients, strawberries contain more vitamin C, which enhances iron absorption from other foods.

C) "I can take an iron supplement with milk to enhance the effect.": Milk and other dairy products can inhibit iron absorption due to their calcium content. It is recommended to take iron supplements with vitamin C-rich beverages like orange juice to enhance absorption.

D) "I should consume coffee or tea with my meals.": Coffee and tea contain compounds like polyphenols that can inhibit iron absorption when consumed with meals. It's better to avoid these beverages around meal times to improve iron absorption.

A. A client refuses to discuss treatment options with her provider following a terminal diagnosis. B. A client promises a higher power to live a better life if his cancer is healed. C. A client withdraws from his social network following the death of a loved one. D. A client yells at healthcare staff following the death of a loved one.

Correct Answer is A

Explanation

A) A client refuses to discuss treatment options with her provider following a terminal diagnosis: This behavior exemplifies denial, the first stage in Kübler-Ross's five stages of grief. In this stage, individuals are unable to accept the reality of their situation, often refusing to acknowledge the facts and avoiding discussions that might confirm the severity of their condition.

B) A client promises a higher power to live a better life if his cancer is healed: This illustrates the bargaining stage, where individuals attempt to negotiate or make deals with a higher power or fate to reverse or delay the loss or illness. They hope that by promising to change their behavior, they can influence the outcome.

C) A client withdraws from his social network following the death of a loved one: Withdrawal from social interactions is indicative of the depression stage, where individuals may feel profound sadness, hopelessness, and a desire to isolate themselves as they process the magnitude of their loss.

D) A client yells at healthcare staff following the death of a loved one: This behavior is characteristic of the anger stage, where individuals express their frustration and helplessness through anger, often directed at people around them, including healthcare providers. This stage reflects the struggle to find meaning and control in the face of loss.

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A nurse in an emergency department is caring for an older adult client who has diabetes mellitus and is in a hyperglycemic-hyperosmolar state. Which of the following actions should the nurse take first?

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