You enter the room of your known diabetic patient and find them unresponsive. After ensuring they are breathing and have a patent airway, you check a blood glucose and find it to be 30 mg/dL. Which of the following medications should be the priority to administer?

15-30g oral carbohydrates.

10% dextrose continuous IV infusion

Glucagon PO,

50% dextrose in water (050W) IV push

Answer and Explanation

The Correct Answer is D

A. 15-30g oral carbohydrates:
Oral carbohydrates are a first-line treatment for hypoglycemia in a conscious, alert patient who can safely swallow. However, since the patient is unresponsive, administering oral carbohydrates is not an appropriate option. The patient’s inability to swallow safely increases the risk of aspiration, making IV treatment the priority in this case.

B. 10% dextrose continuous IV infusion:
A 10% dextrose IV infusion can be used in the management of hypoglycemia, but in an acute, emergency setting where the patient is unresponsive and their blood glucose is critically low (30 mg/dL), a rapid-acting intervention is needed. A bolus dose of a concentrated solution, such as 50% dextrose, is more appropriate for quickly raising the blood glucose level in this situation, rather than a continuous infusion, which takes longer to achieve an effective increase in glucose.

C. Glucagon PO:
Glucagon is typically used for hypoglycemia in patients who are unconscious or unable to take oral glucose. However, glucagon is typically administered intramuscularly (IM) or subcutaneously (SQ), not orally (PO). Administering glucagon orally is ineffective, as it would not be absorbed by the body in the necessary manner to correct hypoglycemia. Therefore, this option is inappropriate.

D. 50% dextrose in water (50% DW) IV push:
When a patient is unresponsive and their blood glucose level is critically low (30 mg/dL), the priority treatment is an immediate, concentrated source of glucose. Administering 50% dextrose IV push is the most appropriate intervention in this scenario. It provides a rapid and effective increase in blood glucose levels, which is critical for reversing hypoglycemia in an emergency situation. This is the fastest and most direct approach to treating severe hypoglycemia in an unresponsive patient.

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Correct Answer is C

Explanation

A. Intramuscular epinephrine:
Intramuscular epinephrine is typically used in cases of anaphylactic reactions, which present with symptoms such as difficulty breathing, swelling, hives, and hypotension. Flank and lower back pain are not typical signs of an anaphylactic reaction during a blood transfusion. Instead, flank pain may suggest a hemolytic reaction, which involves the destruction of red blood cells, not an allergic or anaphylactic response. Thus, epinephrine would not be the first-line treatment for this situation.

B. Intravenous corticosteroids:
Intravenous corticosteroids are often used for inflammatory reactions, such as in cases of autoimmune diseases or severe allergic reactions. While corticosteroids might be used for certain types of transfusion reactions, they are not the primary treatment for hemolytic reactions (which could cause flank and lower back pain). The primary goal in a transfusion reaction with flank pain is to manage potential hemolysis and prevent kidney damage, which would be addressed through hydration and other supportive measures.

C. High volume IV fluids:
High-volume IV fluids are the most appropriate immediate intervention for a client who is experiencing flank and lower back pain during a blood transfusion, which are signs of a potential hemolytic reaction. Hemolysis, or the breakdown of red blood cells, can lead to kidney injury, so increasing fluid volume helps flush the kidneys, promote diuresis, and reduce the risk of kidney damage. The fluids also help to dilute any hemoglobin that is released into the bloodstream, supporting the kidneys' ability to filter it out. This is the priority intervention in this scenario.

D. PO diphenhydramine:
Oral diphenhydramine is used for allergic reactions, such as mild reactions involving itching, rashes, or hives, but it is not appropriate for managing more severe transfusion reactions, such as hemolytic reactions, that cause flank and lower back pain. Diphenhydramine would not address the underlying issue of potential hemolysis and kidney injury. Therefore, it is not the correct intervention for this situation.

A. Antiretrovirals (such as Zidovudine, Entacavir) B. Stool softeners and laxatives (such as Docusate, Senna) C. Corticosteroids or immunosuppressants (such as Prednisone, Sulfasalazine) D. Sulfamethoxazole trimethoprim (SMX-TMP. Bactrim)

Correct Answer is C

Explanation

Inflammatory Bowel Disease (IBD) includes Crohn’s disease and ulcerative colitis, both of which involve chronic inflammation of the gastrointestinal tract. During an exacerbation, treatment focuses on reducing inflammation and controlling symptoms.

Corticosteroids (e.g., Prednisone): Used for short-term inflammation control during flare-ups.
Immunosuppressants (e.g., Sulfasalazine, Azathioprine, Methotrexate): Help maintain remission and reduce immune system overactivity.
Biologic agents (e.g., Infliximab, Adalimumab): Used for severe cases or when other treatments fail.

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You enter the room of your known diabetic patient and find them unresponsive. After ensuring they are breathing and have a patent airway, you check a blood glucose and find it to be 30 mg/dL. Which of the following medications should be the priority to administer?

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