The nurse prepares to teach four clients about diabetes mellitus. Which client has the greatest need for instructions?

Reference Range:

Glycosylated hemoglobin A1C (HbA1C) [good glycemic control: less than 10%]

Random blood glucose [less than or equal to 200 mg/dL (less than 11.1 mmol/L]

Postprandial glucose (1-hour gestational diabetes) [less than 140 mg/dL (less than 7.8 mmol/L)]

Fasting blood glucose [70 to 110 mg/dL (less than 6.1 mmol/L)]

A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L).

An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L).

A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L).

An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%.

Answer and Explanation

The Correct Answer is A

A. A child with asthma, who takes prednisone and has a fasting serum glucose of 180 mg/dL (10 mmol/L): This client’s fasting glucose is well above the normal range. Prednisone can increase blood glucose levels, placing the child at risk for hyperglycemia. This indicates a need for urgent education on blood glucose management while on steroids.

B. An adolescent male who has type 1 diabetes and a random glucose at 120 mg/dL (6.7 mmol/L): This blood glucose level is within normal limits for random testing. No immediate need for change in diabetic teaching is evident based on this value.

C. A female who has gestational diabetes and has a 1-hour postprandial glucose at 140 mg/dL (7.8 mmol/L): Her result meets the upper limit range for gestational diabetes. While she requires ongoing monitoring, her values do not indicate a need for urgent intervention.

D. An adult who has type 2 diabetes and has a glycosylated hemoglobin (Hb A1C) at 10%: Although this indicates poor long-term control, it reflects a chronic issue. The child with an acutely elevated fasting glucose and corticosteroid use is at greater immediate risk and thus has higher priority for education.

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Free Nursing Study Resources

Correct Answer is B,A,D,C

Explanation

1. B. Verify the insulin prescription: The first step is to verify the prescription to ensure the correct type and dose of insulin before administering it. This ensures one is following the appropriate instructions.

2. A. Obtain blood glucose level: The next step is to check the client's blood glucose level to determine the amount of insulin needed based on the sliding scale.

3. D. Cleanse the selected site: After obtaining the blood glucose level, the next step is to prepare the injection site by cleaning it properly to prevent infection.

4. C. Draw insulin into insulin syringe: Finally, drawing the appropriate amount of insulin into the syringe, based on the sliding scale and the blood glucose level, to administer the injection.

A. Recommend substituting opioids with other pain medication. B. Explore other coping stategies aside from using medications. C. Provide a list of local Narcotics Anonymous meetings. D. Explain that opioid abuse poses a great risk to life.

Correct Answer is B

Explanation

A. Recommend substituting opioids with other pain medication: Simply switching to another pain medication without addressing underlying misuse behaviors may reinforce dependency. This overlooks the denial and psychological aspects of addiction.

B. Explore other coping strategies aside from using medications: This client-centered approach gently addresses the issue without direct confrontation. It encourages self-reflection, promotes healthy alternatives, and meets the client where they are in terms of readiness for change, which is essential in early recovery.

C. Provide a list of local Narcotics Anonymous meetings: Although this is useful, offering it during the first interaction with a client in denial may lead to resistance. Engagement and trust-building through conversation about alternatives are more effective initially.

D. Explain that opioid abuse poses a great risk to life: Providing factual information about risk can be helpful, but directly labeling it as abuse when the client is in denial may trigger defensiveness. It is more therapeutic to explore behaviors and build insight before confrontation.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B,A,D,C

Explanation

Correct Answer is B

Explanation

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