A Type 1 diabetic client’s blood glucose level is 50 mg/dL at 16:30. The client is alert; however, dinner will not be served until 17:15. What should be the nurse’s initial action?

Have the client drink 4 oz. of orange juice

Give the client 3 tbsp.

of sugar dissolved in 4 oz. of grape juice to drink

Monitor the client closely until dinner arrives

Answer and Explanation

The Correct Answer is A

Step 1 is to understand that a blood glucose level of 50 mg/dL is considered hypoglycemic. Immediate treatment is necessary to raise the blood glucose level.

Step 2 is to follow the 15-15 rule for treating hypoglycemia, which recommends consuming 15 grams of carbohydrates and then checking blood glucose levels after 15 minutes. Four ounces of orange juice contains about 15 grams of carbohydrates and can quickly raise blood glucose levels.

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Correct Answer is C

Explanation

Choice A rationale

While a past medical history of myocardial infarction does increase the risk of deep vein thrombosis (DVT), it is not the highest risk factor among the options provided. Other factors such as immobility, surgery, and certain medical conditions can pose a higher risk.

Choice B rationale

Postoperative patients, such as those who have had a laparoscopic knee replacement, are at an increased risk for DVT due to periods of immobility and changes in blood flow and clotting.

However, the risk is not as high as in patients who have undergone major open abdominal surgery.

Choice C rationale

Patients who have undergone major open abdominal surgery are at the highest risk for the development of DVT among the options provided. The surgery itself, along with the postoperative period of immobility, significantly increases the risk of DVT34567.

Choice D rationale

While peptic ulcers can be associated with certain risk factors for DVT, such as age and immobility due to pain, they do not pose as high a risk as major open abdominal surgery.

A. Activated Partial Thromboplastin Time (aPTT) of 25. B. D-dimer of 500 ng/mL. C. Prothrombin Time (PT) of 14 seconds. D. Platelet count of 148,000 uL.

Correct Answer is B

Explanation

Choice A rationale

Activated Partial Thromboplastin Time (aPTT) of 25 is within the normal range (25-35 seconds) and is not directly related to deep vein thrombosis (DVT)89.

Choice B rationale

A D-dimer level of 500 ng/mL is elevated (normal range is typically less than 250 ng/mL), which can indicate the presence of a clot, such as in DVT8910.

Choice C rationale

Prothrombin Time (PT) of 14 seconds is within the normal range (11-13.5 seconds) and is not directly related to DVT89.

Choice D rationale

A platelet count of 148,000 uL is within the normal range (150,000-450,000 uL) and is not directly related to DVT89.

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A Type 1 diabetic client’s blood glucose level is 50 mg/dL at 16:30. The client is alert; however, dinner will not be served until 17:15. What should be the nurse’s initial action?

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Naxlex Comprehensive Predictor Exams

The nurse is caring for the following four clients on the nursing unit. Which client is at the highest risk for the development of deep vein thrombosis?

Correct Answer is C

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

The nurse is caring for a client who is being evaluated for possible deep vein thrombosis of the right extremity. Which laboratory result is of most concern to the nurse?

Correct Answer is B

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

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A Type 1 diabetic client’s blood glucose level is 50 mg/dL at 16:30. The client is alert; however, dinner will not be served until 17:15. What should be the nurse’s initial action?