A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?
Perform a blood sugar analysis.
Have the client drink a 4-ounce (120-mL) glass of orange juice.
Administer 1 ampule of 50% dextrose intravenously.
Administer 10 units of regular insulin subcutaneously.
The Correct Answer is B
A. Performing a blood sugar analysis is important, but in the case of sudden symptoms such as weakness, shakiness, and dizziness, it is crucial to act quickly to address the potential hypoglycemia without delay.
B. Having the client drink a 4-ounce glass of orange juice is the most appropriate initial response as it provides a quick source of glucose to alleviate symptoms of hypoglycemia, which is a common concern in clients with type 1 diabetes experiencing these symptoms.
C. Administering 1 ampule of 50% dextrose intravenously is an effective treatment for hypoglycemia but is typically reserved for severe cases where the patient is unable to consume oral glucose or is unconscious.
D. Administering 10 units of regular insulin subcutaneously would exacerbate the problem by lowering blood sugar further and is contraindicated in a patient experiencing hypoglycemic symptoms.
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Correct Answer is ["B","C","D"]
Explanation
A. Sitting up comfortably in bed is not ideal for nasal spray administration; the client should be in an upright position, possibly sitting on the edge of a chair.
B. Tilting the head slightly to the side is correct; this position helps the medication to be delivered effectively to the nasal passages.
C. Inserting the tip of the nose piece into one nostril is correct; this ensures that the medication is delivered directly into the nasal cavity.
D. Holding the breath for a few seconds after administering the spray is correct; this allows for better absorption of the medication in the nasal mucosa.
E. Blowing the nose 1 minute after administering the spray is incorrect; the client should avoid blowing their nose for at least a few minutes after administration to allow the medication to be absorbed effectively.
Correct Answer is B
Explanation
A. "I will take this medication at bedtime to help with my symptoms." is correct; famotidine is often taken at bedtime to reduce nocturnal gastric acid secretion and help manage symptoms.
B. "I can take this medication with antacids for faster relief." is incorrect; antacids can interfere with the absorption of famotidine, and patients should be advised to separate the doses by at least an hour.
C. "I should avoid alcohol while taking this medication." is correct; alcohol can increase the risk of gastrointestinal irritation and should generally be avoided.
D. "I will monitor for signs of unusual bleeding or bruising." is correct; while famotidine is not typically associated with bleeding risks, monitoring for signs of unusual bleeding is a good practice when taking any medication, particularly in patients with risk factors.