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A school nurse is assessing an adolescent who reports feeling shaky and is having difficulty speaking and concentrating on the Questions the nurse is asking. The nurse checks the adolescent’s blood glucose level and identifies a value of 55 mg/dL. Which of the following findings should the nurse expect?

A.

Polyuria.

B.

Dry, flushed skin.

C.

Deep, rapid respirations.

D.

Tachycardia.

Answer and Explanation

The Correct Answer is D

Choice A rationale

 

Polyuria, or excessive urination, is typically associated with hyperglycemia rather than hypoglycemia. In the context of diabetes, polyuria occurs when high blood glucose levels lead to increased urine production as the body attempts to excrete excess glucose. Since the adolescent’s blood glucose level is 55 mg/dL, which indicates hypoglycemia, polyuria is not an expected finding.

 

Choice B rationale

 

Dry, flushed skin is a common symptom of hyperglycemia, not hypoglycemia. When blood glucose levels are high, the body becomes dehydrated, leading to dry skin and a flushed appearance. In contrast, hypoglycemia often presents with symptoms such as sweating, pallor, and shakiness due to the body’s response to low blood glucose levels.

 

Choice C rationale

 

Deep, rapid respirations, also known as Kussmaul respirations, are typically associated with diabetic ketoacidosis (DKA), a complication of hyperglycemia. DKA occurs when the body produces high levels of ketones due to insufficient insulin. Since the adolescent’s blood glucose level is 55 mg/dL, which indicates hypoglycemia, deep, rapid respirations are not an expected finding.

 

Choice D rationale

 

Tachycardia, or an increased heart rate, is a common symptom of hypoglycemia. When blood glucose levels drop, the body releases catecholamines (such as adrenaline) to raise blood glucose levels. This response leads to symptoms such as shakiness, sweating, and tachycardia. Therefore, tachycardia is an expected finding in an adolescent with a blood glucose level of 55 mg/dL.


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View Related questions

Correct Answer is A

Explanation

Choice A rationale

Obtaining an influenza vaccine annually is crucial for individuals with type 1 diabetes mellitus. People with diabetes are at a higher risk of complications from infections, including influenza. The flu can lead to elevated blood sugar levels and potentially worsen diabetes control.
Therefore, getting the flu vaccine can help prevent or reduce the severity of the flu and its complications.

Choice B rationale

Administering glucagon is used for severe hypoglycemia, not hyperglycemia. Glucagon is a hormone that raises blood glucose levels by stimulating the liver to release stored glucose. It is typically used in emergency situations when a person with diabetes has very low blood sugar and is unable to consume sugar orally.

Choice C rationale

Insulin should be injected into subcutaneous tissue, not the deltoid muscle. The preferred injection sites for insulin are areas with more subcutaneous fat, such as the abdomen, thighs, buttocks, and upper arms. Injecting insulin into muscle tissue can lead to faster absorption and unpredictable blood glucose levels.

Choice D rationale

Glyburide is an oral medication used to treat type 2 diabetes, not type 1 diabetes. Type 1 diabetes requires insulin therapy because the body does not produce insulin. Glyburide works by stimulating the pancreas to release more insulin, which is not effective for individuals with type 1 diabetes who have little to no insulin production.

Correct Answer is D

Explanation

Choice A rationale

While some children may pull their ears when they have a cold, it is not a definitive sign of acute nasopharyngitis. Ear pulling can also indicate other issues such as ear infections.

Choice B rationale

Antibiotics are not typically prescribed for acute nasopharyngitis, as it is usually caused by a viral infection. Antibiotics are only used if there is a secondary bacterial infection.

Choice C rationale

Healthy children can have multiple colds per year, especially if they are exposed to other children in settings like daycare or school. It is not uncommon for children to have several colds annually.

Choice D rationale

A cough that accompanies a cold should not be suppressed as it helps clear mucus from the airways. Suppressing the cough can lead to mucus buildup and potential complications.

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