- 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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Regular: Regular insulin is a short-acting insulin, typically used for mealtime glucose control. It has a short duration of action (4-6 hours) and is not considered long-lasting insulin.
B. Insulin glargine (Lantus): Insulin glargine (Lantus) is a long-acting insulin that provides a steady release of insulin over a 24-hour period, without a peak, making it ideal for basal insulin coverage. It is designed to maintain blood glucose levels consistently throughout the day and night.
C. Insulin aspart (NovoLog): Insulin aspart is a rapid-acting insulin used primarily for mealtime glucose control, and it has a short duration of action, usually around 2-4 hours.
D. Insulin lispro (Humalog): Insulin lispro is a rapid-acting insulin that works quickly to control post-meal blood sugar but is not long-lasting. It typically lasts for about 3-5 hours.
Correct Answer is D
Explanation
A. Bulging eyeballs: Bulging eyeballs (exophthalmos) is typically associated with hyperthyroidism, particularly in Graves' disease, not hypothyroidism. In myxedema (severe hypothyroidism), eye changes are not characterized by bulging.
B. Thin silky hair: Hypothyroidism is more likely to cause dry, coarse hair, not thin or silky hair. Hair thinning is common, but it tends to become more brittle and coarse in hypothyroidism.
C. Fine muscle tremors: Fine muscle tremors are more characteristic of hyperthyroidism. In hypothyroidism, the muscle tone is often reduced, and some patients may experience muscle weakness or cramping, rather than fine tremors.
D. Periorbital edema: Periorbital edema (swelling around the eyes) is a common finding in myxedema and hypothyroidism. It is due to the accumulation of mucopolysaccharides and water in the tissues, which is a hallmark of severe, untreated hypothyroidism.
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