A patient taking insulin reports feeling shaky, sweaty, and anxious.
What is the most appropriate nursing action?
Give them a glass of water and reassess later.
Administer a carbohydrate-rich snack.
Encourage them to exercise to burn off the glucose.
Administer a protein-rich snack.
The Correct Answer is B
Choice A rationale
The patient's symptoms of shakiness, sweating, and anxiety are classic signs of hypoglycemia, a low blood glucose level. Giving them only a glass of water will not raise their blood glucose level and will not correct the underlying issue. The brain needs glucose to function, and without a rapid source, the patient could progress to more severe symptoms, including confusion, loss of consciousness, or seizures.
Choice B rationale
A carbohydrate-rich snack, such as a glass of juice or a few glucose tablets, provides a rapid source of glucose that can be quickly absorbed and utilized by the body. This action will promptly raise the patient's blood glucose level, reversing the hypoglycemic episode and alleviating the symptoms. This is the most effective and appropriate initial nursing action for a conscious patient experiencing hypoglycemia.
Choice C rationale
Exercising would further deplete the body's glucose stores, worsening the hypoglycemic state. Physical activity increases glucose utilization by muscles, which would lower the already deficient blood glucose level. This action would be dangerous and could cause the patient's condition to deteriorate rapidly, leading to a medical emergency. Exercise should only be encouraged after blood glucose has been stabilized.
Choice D rationale
A protein-rich snack takes longer to digest and convert into glucose, so it will not provide the rapid increase in blood sugar needed to treat an acute hypoglycemic event. While protein can help to stabilize blood glucose levels after they have been raised with a carbohydrate source, it is not the appropriate first-line treatment for a patient experiencing acute hypoglycemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Cortisol is a glucocorticoid hormone produced by the adrenal cortex. It is involved in the body's stress response, metabolism, and immune function, but is not produced by the thyroid gland, which is primarily focused on metabolic regulation.
Choice B rationale
Thyroxine, also known as T4, is the main hormone produced by the thyroid gland. It is a key regulator of metabolism, growth, and development. The thyroid also produces a smaller amount of triiodothyronine (T3), which is more potent than T4.
Choice C rationale
Insulin is a hormone produced by the beta cells of the pancreas. Its primary role is to regulate blood glucose levels by promoting the uptake of glucose into cells for energy or storage. It is not associated with thyroid function.
Choice D rationale
Adrenaline, or epinephrine, is a hormone produced by the adrenal medulla. It is a crucial part of the "fight or flight" response, increasing heart rate, blood pressure, and glucose release from stores, and is unrelated to the thyroid gland.
Correct Answer is B
Explanation
Choice A rationale
Increasing myocardial oxygen demand would be detrimental in coronary artery disease (CAD), as the underlying issue is an imbalance between oxygen supply and demand. Medications aim to decrease demand and increase supply to prevent myocardial ischemia and infarction, so this is not a goal of pharmacotherapy.
Choice B rationale
The primary goal of pharmacotherapy in coronary artery disease is to reduce myocardial oxygen demand and supply balance. This is achieved by using medications that decrease heart rate, contractility, and blood pressure (reducing demand), while simultaneously increasing blood flow to the myocardium (improving supply). This helps prevent ischemia.
Choice C rationale
Promoting vasoconstriction would be harmful in CAD, as it would further narrow already stenotic coronary arteries, thereby decreasing blood flow and oxygen supply to the myocardium. The goal of many CAD medications, such as nitroglycerin, is vasodilation to improve blood flow.
Choice D rationale
Increasing blood viscosity would be counterproductive, as it would make blood thicker and more difficult to pump through narrowed coronary arteries. This would increase the workload on the heart and further compromise oxygen supply, increasing the risk of thrombotic events and myocardial infarction.
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