Question

A nurse is caring for a client who has diabetes mellitus and reports feeling dizzy, weak, and shaky. Which of the following is the priority action by the nurse?

a. Administer insulin as prescribed
b. Provide a sugary snack or beverage
c. Encourage the client to exercise immediately
d. Assess the client's blood glucose level

Answer 1

The priority action by the nurse for a client with symptoms of feeling dizzy, weak, and shaky, especially in the context of diabetes mellitus, is:

d. Assess the client's blood glucose level.

This is crucial to determine whether the symptoms are related to hypoglycemia (low blood sugar). Administering insulin (option a) without knowing the current blood glucose level can potentially worsen hypoglycemia. Providing a sugary snack or beverage (option b) is generally appropriate for treating hypoglycemia, but assessing the blood glucose level first is essential. Encouraging immediate exercise (option c) may not be safe if the client's blood glucose is low. Therefore, assessing the blood glucose level is the priority to guide appropriate interventions.

Answer 2

The priority action for a client with diabetes reporting dizziness, weakness, and shakiness is to assess their blood glucose level to determine if they are experiencing hypoglycemia before considering other interventions.

Step-by-step explanation:

If a client with diabetes mellitus reports feeling dizzy, weak, and shaky, the priority action by the nurse would be to assess the client's blood glucose level. These symptoms could indicate hypoglycemia, a state of low blood sugar. Administering insulin, as suggested in options (a) and (c), would be inappropriate without first confirming the blood glucose level since insulin decreases blood glucose levels. Option (b) may be necessary if hypoglycemia is confirmed, but it should not be provided before assessment. Encouraging the client to exercise, option (c), is not the priority, as it could further lower glucose levels and exacerbate the condition. Therefore, the correct response is to first assess the blood sugar level.