Page 961 - Saunders Comprehensive Review For NCLEX-RN

more than 30 minutes or if activity is planned. If the child becomes unconscious,
cake frosting or glucose paste is squeezed onto the gums, and the blood glucose level
is retested in 15 minutes; if the reading remains low, additional glucose is
administered. If the child remains unconscious, administration of glucagon may be
necessary, and the nurse should be prepared for this intervention. Encouraging the
child to ambulate and administering regular insulin would result in a lowered blood
glucose level. Providing electrolyte replacement therapy intravenously is an
intervention to treat diabetic ketoacidosis. Waiting 30 minutes to confirm the blood
glucose level delays necessary intervention.
Test-Taking Strategy: Focus on the subject, a low blood glucose level, and on the
information in the question. Think about the pathophysiology associated with
hypoglycemia and how it is treated. Recalling that a blood glucose level of 60 mg/dL
(3.4 mmol/L) indicates hypoglycemia will assist in determining the correct
interventions.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pediatrics: Metabolic/Endocrine
Health Problem: Pediatric-Specific: Diabetes mellitus
Priority Concepts: Clinical Judgment; Glucose Regulation
Reference: Hockenberry, Wilson, Rodgers (2017), pp. 932, 936.

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