The nurse is caring for a hospitalized child newly diagnosed with type 1 diabetes mellitus. At 1100, the child suddenly complains of weakness, headache, and blurred vision. How would the nurse respond?
Give the child 1⁄2 cup of orange juice to drink.
Call the dietary department and ask that the lunch tray be delivered early.
Contact the physician.
Obtain a blood glucose reading
The Correct Answer is A
A. Give the child 1⁄2 cup of orange juice to drink. These symptoms indicate hypoglycemia, a common early complication of diabetes treatment. Orange juice contains quick-acting sugars that can rapidly raise blood glucose levels and alleviate symptoms. This is the immediate action to manage the child's symptoms.
B. Call the dietary department and ask that the lunch tray be delivered early. Delayed action compared to treating the immediate hypoglycemia.
C. Contact the physician. While eventually necessary, immediate treatment of hypoglycemia takes precedence.
D. Obtain a blood glucose reading. Important to confirm hypoglycemia but not as urgent as providing immediate treatment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "I will report changes in breathing or signs of confusion." Correct action as changes in breathing or confusion can indicate diabetic ketoacidosis or other serious complications.
B. "I will encourage him to drink a half a cup of water or sugar-free fluid every 30 minutes."Ensuring adequate fluid intake helps prevent dehydration and helps manage blood sugar levels during illness.
C. "I will notify the doctor if his temperature is not controlled with acetaminophen." Correct action as fever may indicate an infection that needs further medical evaluation and treatment.
D. "I will continue to check his blood sugar two times every day." When a child with diabetes is ill, blood sugar should be monitored more frequently, typically every 3-4 hours, to manage the risk of hyperglycemia or hypoglycemia due to illness.
Correct Answer is B
Explanation
A. Dry mucous membranes. Associated with dehydration, not hypoglycemia.
B. Diaphoresis. Sweating (diaphoresis) is a common symptom of hypoglycemia due to the body’s response to low blood glucose levels.
C. Polyuria. Associated with hyperglycemia, where there is an excess of glucose leading to increased urine output.
D. Fruity breath odor. Indicates ketosis, which is a sign of hyperglycemia and diabetic ketoacidosis, not hypoglycemia.
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