A hospitalized diabetic child is sweating, nauseated, and has a headache. What action by the nurse takes priority?
A.
Administer sliding-scale insulin.
B.
Call laboratory for a stat blood sugar.
C.
Give the child some orange juice.
D.
Perform a urine ketone test.
ANS: C
This child is exhibiting signs of hypoglycemia. The nurse should first treat the child instead of waiting for the laboratory to come draw blood. If the nurse has bedside glucose monitoring available, check the glucose first, then treat, but do not wait the several minutes it will take for phlebotomy. Because the child has low blood sugar, do not give insulin. Do not delay by trying to get a urine sample; also, ketones are present in hyperglycemia.
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