A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide.
Which of the following instructions should the nurse provide?

This question assesses the patient's ability to respond to acute hypoglycemia, a common complication of insulin therapy. It requires identifying the correct evidence-based intervention, the rule of 15, to rapidly increase blood glucose levels and prevent the progression to severe neurological symptoms.

Choice A rationale

Resting until symptoms pass is dangerous and contraindicated. Hypoglycemia is a metabolic emergency where the brain lacks essential fuel; delay in treatment can lead to seizures, loss of consciousness, coma, and potential permanent neurological damage if not corrected immediately.

Choice B rationale

Administering more insulin when the blood glucose is 48 mg/dL is a critical error that would further lower the already dangerously low blood sugar. This could quickly cause a life-threatening hypoglycemic crisis, leading to cardiac arrhythmia or severe central nervous system depression.

Choice C rationale

Calling the doctor is appropriate only after the immediate treatment of the hypoglycemia has been initiated. The patient must prioritize the ingestion of rapid-acting carbohydrates to stabilize their blood glucose levels first, ensuring safety before seeking further medical consultation.

Choice D rationale

Taking 15 grams of rapid-acting oral glucose is the standard of care for a blood glucose level below 70 mg/dL. This effectively raises blood glucose levels quickly, alleviating symptoms and preventing the development of severe hypoglycemia and its associated neurological complications.

This question assesses knowledge of drug contraindications. It requires identifying the liver as the primary site of acetaminophen metabolism and recognizing that in patients with severe hepatic impairment, the risk of hepatotoxicity is drastically increased, necessitating an alternative analgesic to ensure patient safety and prevent failure.

Choice A rationale

Acetaminophen is a safe and effective antipyretic for patients with high fever. A fever of 103.4 degrees F is not a contraindication for acetaminophen, as it is standard practice to use this medication to reduce febrile responses in hospitalized patients.

Choice B rationale

Acetaminophen is an effective analgesic for postoperative pain and does not have the adverse gastrointestinal or coagulation side effects associated with NSAIDs. It is typically a safe and appropriate choice for pain management in patients recovering from abdominal surgical procedures.

Choice C rationale

Acetaminophen is metabolized in the liver. In severe hepatitis, hepatic function is critically impaired, significantly increasing the risk of toxic metabolite accumulation. Therefore, acetaminophen is contraindicated, and an alternative analgesic must be selected to prevent further liver damage in the patient.

Choice D rationale

Acetaminophen does not inhibit platelet aggregation or affect the coagulation cascade. It is an appropriate analgesic choice for patients with deep vein thrombosis, as it does not interfere with their anticoagulant therapy or pose a risk of bleeding complications.