NCLEX Exam Practice Question of the Week - 8/1/12

Elsevier NCLEX Exam Review

Question: A client is found to be comatose and hypoglycemic with a blood glucose level of 50 mg/dL. What nursing action is implemented first?

1. Infuse 1000 mL of D5W over a 12-hour period
2. Administer 50% glucose intravenously
3. Check the client's urine for the presence of sugar and acetone
4. Encourage the client to drink orange juice with added sugar.

Answer: 2

Rationale:  The unconscious, hypoglycemic client needs immediate treatment with 50% intravenous glucose (highly concentrated). 1000 mL of D5W over 12 hours does not provide enough glucose to treat the problem. Trying to give oral fluids to an unconscious client should never be done, because it increases the risk for aspiration. Urine sugar does not need to be evaluated if the serum blood glucose is available.                             

This week’s NCLEX exam practice question came from:

Zerwekh: Illustrated Study Guide for the NCLEX-RN Examination, 7th Edition, Chapter 13, Page 251 Question 4

Check out other great NCLEX exam review resources from Elsevier!