A nurse is caring for a 24-year-old female client in the postpartum unit. The client has a history of type 1 diabetes mellitus, first diagnosed at 14 years of age, and is on insulin for diabetes management. The client is gravida 1 para 1 following a spontaneous vaginal birth at 37 weeks of gestation. The newborn was large for gestational age, weighing 4.1 kg (9 lb). The client has a third-degree laceration that required several stitches.
Drag words from the choices below to fill in each blank in the following sentence.
Sentence: The nurse should plan to
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}
The nurse should plan to B. check the client’s blood glucose level and A. obtain a urine sample to test for ketones.
Explanation:
- Check the client’s blood glucose level: Given the client’s history of type 1 diabetes mellitus and her current symptoms (diaphoresis, clammy skin, headache, nausea, and weakness), it is crucial to check her blood glucose level to rule out hypoglycemia or hyperglycemia, despite the recent blood glucose reading of 120 mg/dL.
- Obtain a urine sample to test for ketones: Testing for ketones is important in diabetic patients, especially when they present with symptoms that could indicate diabetic ketoacidosis (DKA), such as nausea, weakness, and a history of type 1 diabetes.
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Related Questions
Correct Answer is A
Explanation
Choice A rationale
A hemoglobin level of 9.5 g/dL is low for a full-term newborn and should be reported to the provider. Normal hemoglobin levels for newborns range from 14 to 24 g/dL4.
Choice B rationale
A white blood cell count of 10,000/mm³ is within the normal range for a newborn, which is typically between 9,000 and 30,000/mm³4.
Choice C rationale
A glucose level of 60 mg/dL is within the normal range for a newborn, which is typically between 40 and 60 mg/dL4.
Choice D rationale
A platelet count of 225,000/mm³ is within the normal range for a newborn, which is typically between 150,000 and 450,000/mm³4.
Correct Answer is D
Explanation
Choice A rationale
Assessing the client’s socioeconomic status is important but not the primary action the nurse should take in the maternal newborn unit. The focus should be on providing unbiased teachings based on the client’s needs.
Choice B rationale
Collecting a dietary history is important but not the primary action the nurse should take in the maternal newborn unit. The focus should be on providing unbiased teachings based on the client’s needs.
Choice C rationale
Determining the best method of contraception for the client is important but not the primary action the nurse should take in the maternal newborn unit. The focus should be on providing unbiased teachings based on the client’s needs.
Choice D rationale
Performing unbiased teachings based on the client’s needs is the primary action the nurse should take in the maternal newborn unit. This ensures that the client receives accurate and relevant information tailored to their specific situation.
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