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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 C

Explanation

Choice A rationale

Varying the child’s schedule each day can create a sense of unpredictability and insecurity. According to Erikson’s theory of psychosocial development, children in this age group (10 years old) are in the stage of industry versus inferiority. They need a sense of routine and structure to develop a sense of competence and accomplishment. A consistent schedule helps them feel secure and focused on their tasks.

Choice B rationale

Providing a daily session with a play therapist can be beneficial for the child’s emotional well- being. However, it does not directly address the child’s need for a sense of competence and accomplishment. According to Erikson’s theory, children in this age group need to develop a sense of industry by mastering tasks and completing school work.

Choice C rationale

Encouraging the client to complete school work helps promote a sense of industry and competence. According to Erikson’s theory, children in this age group need to develop a sense of accomplishment through mastering tasks. Completing school work provides them with a sense of purpose and achievement, which is essential for their psychosocial development.

Choice D rationale

Discouraging visits from the client’s friends can lead to feelings of isolation and loneliness. According to Erikson’s theory, social interactions and relationships are important for the child’s psychosocial development. Encouraging visits from friends can help the child feel connected and supported during their hospitalization.

Correct Answer is D

Explanation

ChoiceA rationale

Hypotensionisnotacommonmanifestationofhypoxemiaduringanasthmaattack.

ChoiceB rationale

Dysphagiaisnotacommonmanifestationofhypoxemiaduringanasthmaattack.

ChoiceCrationale

Nauseaisnotacommonmanifestationofhypoxemiaduring anasthmaattack.

ChoiceD rationale

Agitationisacommonmanifestationofhypoxemiaduringanasthmaattack.Hypoxemiacancauserestlessnessandagitationduetothelackof oxygenin thebody.

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