Question

The client with diabetes presents to the emergency department with pupils dilated. Which action by the nurse indicates understanding of the client's presenting symptom? A. The nurse checks the client's Hgb A1C. B. The nurse begins an IV of normal saline. C. The nurse applies oxygen via mask at 3 liter/minute. D. The nurse gives the client \(240 \mathrm{ml}\) of apple juice.

Short answer

Answer: Give the client 240ml of apple juice.

Step-by-step solution

Analyze each option

Look at the possible actions presented in options A, B, C, and D. A. Checking the client's Hgb A1C: This test measures the average blood sugar levels over the past 2 to 3 months and is typically used for long-term management of diabetes. While it may be helpful in this case, it does not directly address the presenting symptom. B. Starting an IV of normal saline: Initiation of IV fluids may be helpful in some cases of diabetes when a patient presents with complications such as dehydration. However, it doesn't directly address the presenting symptom of dilated pupils. C. Applying oxygen via mask at 3 liters/minute: Providing supplemental oxygen might be beneficial for patients experiencing difficulty with oxygenation or breathing, but it is not directly related to the presenting symptom of dilated pupils in this case. D. Giving the client \(240 \mathrm{ml}\) of apple juice: This action could help if the client is experiencing hypoglycemia (low blood sugar), which can sometimes cause dilated pupils and other visual disturbances. Providing a source of fast-acting sugar, such as apple juice, can help correct hypoglycemia quickly.

Determine the most appropriate action

Among the options presented, option D (giving the client \(240 \mathrm{ml}\) of apple juice) most directly addresses the presenting symptom of dilated pupils by potentially treating an episode of hypoglycemia, which could be causing the visual disturbance. Therefore, option D is the correct answer. Option D: The nurse gives the client \(240 \mathrm{ml}\) of apple juice.