A nurse is caring for a client who has gestational diabetes and reports feeling shaky, sweaty, and having blurred vision. The client's blood glucose level is 48 mg/dL. Which of the following foods should the nurse give to the client? (Select all that apply).

1 tbsp honey

5 hard candies

240 mL regular soda

120 mL unsweetened fruit juice

120 mL milk

Answer and Explanation

Correct Answer : A,B,D

A. 1 tbsp honey: Honey is a quick source of glucose and is an appropriate choice to raise blood sugar rapidly during hypoglycemia.

B. 5 hard candies: Hard candies containing sugar can provide a quick source of glucose and are suitable for treating hypoglycemia.

C. 240 mL regular soda might provide 20 to 30 grams of carbohydrates, which could be too much and may lead to a rebound hypoglycemia after the initial correction of blood glucose levels.

D. 120 mL unsweetened fruit juice: Unsweetened fruit juice provides a quick source of glucose, which is essential for rapidly raising blood sugar levels in a hypoglycemic patient. The sugar in the juice is readily absorbed into the bloodstream, helping to counteract the effects of low blood sugar. It's important to choose unsweetened juice to avoid a sudden spike in blood sugar followed by another drop.

E. 120 mL milk: Milk contains lactose, a natural sugar, but it also contains protein and fat, which can slow down the absorption of sugar into the bloodstream. Therefore, it may not be as effective in rapidly raising blood sugar levels during an episode of hypoglycemia.

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Correct Answer is A

Explanation

A. Flush the tube with water:
This is the correct action to take first. Flushing the tube with water ensures that the tube is clear and functional before administering the bolus enteral feeding.

B. Measure stomach contents:
This is not the first action to take. Before measuring stomach contents, it's important to confirm that the tube is patent and clear by flushing it with water.

C. Elevate the head of the bed:
While elevating the head of the bed is important during and after enteral feedings to reduce the risk of aspiration, it is not the first step. The initial focus should be on verifying the tube's patency.

D. Return gastric content into the gastrostomy tube:
If there is resistance or difficulty flushing the tube, returning gastric contents into the tube may be necessary, but it's not the first action. The first step is to attempt to clear the tube with water.

A. BMI of 20 B. Peripheral neuropathy C. Immobility D. Hypoperfusion E. Prealbumin level of 16 mg/dL

Correct Answer is ["B","C","D","E"]

Explanation

A. BMI of 20:
A BMI of 20 is within the normal range. While extremes of BMI, either low or high, can contribute to health issues, a BMI of 20 alone may not significantly increase the risk of pressure injuries.

B. Peripheral neuropathy:
Peripheral neuropathy, which involves damage to the nerves in the extremities, can lead to decreased sensation and awareness. Clients with peripheral neuropathy may have difficulty sensing pressure, friction, or discomfort, making them more susceptible to pressure injuries.

C. Immobility:
Immobility is a significant risk factor for pressure injuries. Clients who are unable to change positions frequently are more likely to develop pressure points, particularly over bony prominences. Regular repositioning is essential to prevent pressure injuries in immobile individuals.

D. Hypoperfusion:
Hypoperfusion, or inadequate blood flow to tissues, can compromise tissue viability. Proper blood circulation is crucial for delivering oxygen and nutrients to the skin and underlying tissues. Impaired perfusion can contribute to tissue damage and increase the risk of pressure injuries.

E. Prealbumin level of 16 mg/dL:
Prealbumin is a marker of nutritional status. A low prealbumin level (16 mg/dL) indicates malnutrition, which can impair the body's ability to repair and maintain tissues, including the skin. Malnourished individuals are at an increased risk of developing pressure injuries.

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A nurse is caring for a client who has gestational diabetes and reports feeling shaky, sweaty, and having blurred vision. The client's blood glucose level is 48 mg/dL. Which of the following foods should the nurse give to the client? (Select all that apply).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer a bolus enteral feeding to a client who has a gastrostomy tube. Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

A nurse is collecting data on a client. Which of the following findings increase the client's risk of a pressure injury?

Correct Answer is ["B","C","D","E"]

Explanation

A nurse is caring for a client who has dysphagia. The nurse should monitor the client for which of the following complications?

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A nurse is collecting data on a client who has a stage 2 pressure injury. Which of the following findings should the nurse expect?

A charge nurse observes a nurse administer intermittent tube feedings via an NG tube to a client. Which of the following actions should prompt the charge nurse to intervene?

A nurse is caring for an older adult client who is at risk for skin breakdown. Which of the following interventions should the nurse use to help maintain the client's skin integrity?

A nurse is contributing to the plan of care for a client prescribed continuous enteral feedings. Which of the following actions should the nurse plan to take?

A nurse is caring for a client who requires an NG tube. After inserting the tube, the nurse tests the pH of the client's aspirate. Which of the following pH levels should the nurse identify as an indication of correct placement of the tube?