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    Ati Nur 110 Med Surg (Adult And Wellness) Proctored Exam

    Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 assessment findings that support the condition, and 2 priority nursing interventions.

    Explanation & Rationale

    Rationale Condition: The patient's blood glucose is critically low (42 mg/dL). Combined with symptoms of confusion, diaphoresis, and drowsiness, this confirms Hypoglycemia. DKA and HHS involve hyperglycemia (high blood sugar), and while a stroke can mimic these symptoms, the glucose reading points directly to a metabolic cause. Assessment Findings: * Blood glucose 42 mg/dL is the definitive diagnostic finding. Poor oral intake and sulfonylurea use are the likely causes; glipizide stimulates insulin secretion regardless of blood sugar levels, making the patient highly susceptible to drops if they aren't eating. Note: Fruity breath and Kussmaul respirations are associated with DKA, not hypoglycemia. Interventions: * Administer 50% dextrose IV push is the priority because the patient is confused and unable to answer questions clearly, making oral glucose (like juice) a choking risk (aspiration). Recheck blood glucose in 15 minutes is the standard "Rule of 15" protocol to ensure the treatment was effective and to determine if further intervention is needed.

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