The client diagnosed with Type I diabetes calls the clinic with a blood glucose level of 285 mg/dL and symptoms of a sore throat, cough, and fever. The clinic triage nurse advises the client to:

limit intake to non-caloric containing liquids until the glucose is within normal limits.

monitor blood glucose levels every 4 hours and go to the clinic if it continues to rise.

decrease intake of carbohydrates until blood glucose level is less than 200 mg/dL

hold the morning prescribed dose of insulin.

Answer and Explanation

The Correct Answer is B

A.   While staying hydrated is essential, especially during illness, limiting intake to non-caloric liquids could lead to inadequate caloric intake and worsen the client’s condition. Instead, the client should maintain a balanced intake of fluids and carbohydrates as tolerated.
B.   This is a reasonable approach. Monitoring blood glucose levels regularly allows the client to assess how their body is responding to the illness and any adjustments in insulin. If the levels continue to rise, it is important for the client to seek medical attention to prevent complications like diabetic ketoacidosis (DKA).
C.   While it is important to manage carbohydrate intake, completely decreasing carbohydrate intake can lead to inadequate caloric consumption, which is especially risky during an illness. The body needs energy, and people with diabetes must balance carbohydrate intake with insulin administration to avoid complications.
D.   Holding insulin can lead to dangerously high blood glucose levels. Clients with Type 1 diabetes require insulin regardless of illness, and it’s crucial to adjust the insulin regimen based on current blood glucose levels and carbohydrate intake.

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Correct Answer is B

Explanation

A. While monitoring is important, doing nothing to address the hypoglycemia is not safe. A blood glucose level of 50 mg/dL is low and requires immediate intervention to prevent more severe hypoglycemic symptoms or complications.
B. This is a suitable option for treating mild to moderate hypoglycemia. Orange juice is a quick source of carbohydrates and can effectively raise blood glucose levels. Four ounces typically provides enough sugar to help increase the client's blood glucose level before dinner is served.
C. While this option would also effectively raise blood glucose, it is more complicated than simply having the client drink orange juice. The sugar may take additional time to dissolve, and grape juice may not be readily available. In an acute situation, simplicity and speed are key.
D. While hard candy can raise blood glucose levels, it may take longer to dissolve and provide sufficient glucose quickly compared to liquid sources like orange juice or grape juice. Additionally, the amount of candy needed may not be clear, making this a less reliable option in an urgent situation.

A. Instruct the client how to perform biofeedback exercises B. Place the client's residual limb in the dependent position C. Explain to the client his left leg has been amputated D. Medicate the client with narcotic analgesic immediately

Correct Answer is D

Explanation

A. While biofeedback can be a helpful technique for managing pain in the long term, it is not an immediate intervention for acute pain. The client is expressing urgent pain that requires prompt action, so this option does not address the immediate need.
B. Placing the residual limb in a dependent position (below the level of the heart) can increase swelling and may worsen the pain. After surgery, the limb should typically be elevated to minimize swelling, especially in the early postoperative period.

C. While it is important for clients to understand their situation, explaining the amputation does not provide immediate relief for acute pain. The client is likely already aware of the amputation and is in distress, so this option is not a priority at this moment.
D. This is the most appropriate intervention. The client is experiencing significant pain, and administering a narcotic analgesic can provide immediate relief. Pain management is a priority in the postoperative setting, especially in the first few hours after surgery.

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The client diagnosed with Type I diabetes calls the clinic with a blood glucose level of 285 mg/dL and symptoms of a sore throat, cough, and fever. The clinic triage nurse advises the client to:

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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