Case Study #2

Patient Name: Jacob M.

Age: 17

Diagnosis: Type 1 Diabetes Mellitus (T1DM)

History: Diagnosed at age 10, uses insulin pump therapy, active in sports Situation:

Jacob is brought to the emergency department by his coach after collapsing during basketball practice. He is unconscious, diaphoretic, and unresponsive to verbal stimuli. A bedside glucose check reveals a blood sugar of 28 mg/dL.

The nurse prepares to administer glucagon 1 mg IM per emergency protocol.

Which of the following best explains why oral glucose is not appropriate for Jacob at this time?

He has already received insulin

Oral glucose is too slow to act

He is unconscious and at risk for aspiration

He is allergic to glucose

Answer and Explanation

The Correct Answer is C

A. He has already received insulin: While Jacob uses an insulin pump, the immediate issue is severe hypoglycemia. Whether he recently received insulin or not, the priority is to raise his blood sugar. Insulin doesn't preclude oral glucose if the patient is conscious and able to swallow safely.

B. Oral glucose is too slow to act: Oral glucose acts quickly when absorbed, but it is not the preferred option in this situation due to the patient's unconsciousness. Intramuscular glucagon acts more rapidly and is safer for immediate administration.

C. He is unconscious and at risk for aspiration: Since Jacob is unconscious, he is at high risk for aspiration if he were given oral glucose. In such cases, the intramuscular administration of glucagon is preferred to quickly raise blood glucose and avoid the risk of choking or aspiration.

D. He is allergic to glucose: There is no indication in the patient's profile that he has an allergy to glucose, and it would be uncommon for someone with diabetes to be allergic to glucose. The primary concern here is his unconsciousness, not an allergy.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Fowler's: Fowler's position (sitting or semi-sitting) position helps reduce swelling in the neck area, facilitates breathing, and promotes comfort. It also helps in the prevention of respiratory distress due to potential swelling around the surgical site.

B. Trendelenburg: Trendelenburg position (head down, feet elevated) is typically used for shock or hypotension, but it is not appropriate for a patient recovering from thyroid surgery. It can increase pressure on the neck and exacerbate swelling.

C. Supine: Lying flat on the back (supine) is not recommended post-thyroidectomy as it can lead to neck swelling and compromise the airway. It is better to keep the patient in a more elevated position to reduce the risk of respiratory distress.

D. Prone: The prone position (lying on the stomach) is not appropriate after thyroid surgery, as it could place unnecessary pressure on the neck and surgical site, potentially hindering recovery and breathing.

A. Turn the patient on his side B. Administer a second dose of glucagon C. Prepare for intubation D. Give a high-protein snack

Correct Answer is A

Explanation

A. Turn the patient on his side: After administering glucagon to treat severe hypoglycemia, the nurse should turn the patient to their side to prevent aspiration if the patient vomits as they regain consciousness. This is a preventive measure to protect the airway until he wakes up.

B. Administer a second dose of glucagon: Glucagon is usually given once in emergency situations to treat severe hypoglycemia. A second dose is not needed unless the patient remains unresponsive after 15 minutes, but the priority action is to monitor the patient closely after the first dose.

C. Prepare for intubation: There is no immediate evidence suggesting the need for intubation. Jacob’s respiratory rate (12/min) and oxygen saturation (96%) are within reasonable limits. The priority is to monitor his response to glucagon and keep the airway clear.

D. Give a high-protein snack: A high-protein snack should only be given after the patient is awake and alert and able to swallow safely. The immediate priority is to ensure the patient’s safety and monitor their response to glucagon.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

Correct Answer is A

Explanation

After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional instruction?

A patient has asked why she needs to exercise. The nurse tells her that if the diabetic patient exercises, then the insulin requirement

A nurse is collecting a health history from a patient that is taking Levothyroxine for hypothyroidism. Over the past 12 months, the dose of the medication has been increased twice. Which of the following statements made by the patient could be the reason the medication is not effective:

The nurse is developing a care plan for the client diagnosed with type 1 diabetes. The nurse identifies the problem "high risk for hyperglycemia related to noncompliance with the medication regimen." Which statement is an appropriate short-term goal for the client?

The nurse is caring for a patient scheduled for a thyroidectomy. Which instruction should be included in the preoperative care?

Which situation would most appropriately describe a client possibly require glucose management by sliding scale insulin?

The client is admitted to the intensive care department diagnosed with myxedema coma. Which assessement data warrant immediate intervention by the nurse?

The nurse should teach the client to monitor for which complication of diabetic neuropathy?