The LPN/LVN administers glipizide (Glucotrol) 5 mg. before breakfast to an older client. At 10:30 am, the client reports a headache and hunger, and the LPN/LVN notes the client is irritable. Which action should the LPN/LVN take FIRST?
- 1. Contact the physician.
- 2. Offer the client ½ cup of fruit juice.
- 3. Tell the client that lunch will be served at 11 am.
- 4. Suggest that the client go for a walk.
This is a priority questions that is so typical of the NCLEX-PN® examination. This question is also based on a statement in the PN Practice Analysis Linking the PN examination to practice. It is considered a passing question on the NCLEX-PN examination. The LPN/LVN must recognize what is happening to the client and then take action, so this question is also testing your clinical judgment.
“FIRST” says this is a priority question. That means that there is going to be more than one technically correct response, but the LPN/LVN can only take one action. What is it going to be?
We teach the Decision Tree which is based on clinical judgment. Critical thinking is used in clinical judgment, and critical thinking requires the PN/LVN to identifying patterns. What pattern do you see in the answer choices? All of these answers are implementations. Does Maslow fit? 1, 2, and 3 are physical needs. In answer choice #4, why is the LPN/LVN suggesting a walk? The LPN/LVN assumes the irritability is due to the client’s mood. Answer choice #4 is a psychosocial answer. Since physical needs take priority over psychosocial needs, we are going to eliminate this answer. Since 1, 2, and 3 are physical, do the ABCs apply? They do not. So, you are going to have to evaluate the outcome of each answer choice.
Read answer choice 1. Why would you contact the physician? Before deciding that, we have to determine what is going on. Glipizide is an oral hypoglycemic and headache, hunger, and irritability are indications of hypoglycemia. When is the peak action glipizide? It is 1-2 hours after administration. Do you think the first action should be to contact the physician? Maybe. There are probably other things the LPN/LVN should be doing.
Read answer choice 2. Why would you offer a quick-acting carbohydrate such as fruit juice? Because the client’s symptoms indicate hypoglycemia and the LPN/LVN is expected to treat the hypoglycemia. Offer fruit juice, milk, or 6-10 pieces of hard candy. I like this answer, but do not stop here. Let’s look at the next answer.
Read answer choice 3. Why would you tell the client that lunch is being served in 30 minutes? The client is reporting hunger, but the reason is the glipizide is peaking and client symptoms indicate hypoglycemia. If the LPN/LVN tells the client to wait for lunch, the nurse is not caring for the patient’s problem and that has a bad outcome. I am going to eliminate this answer.
Read answer choice 4. Why would the LPN/LVN suggest a walk? We have eliminated based on Maslow, but let’s think about it. This may be appropriate action if the client is restless or anxious, but is this the situation? No, it is not. Eliminate this answer.
So, we eliminated 3 and 4. Between 1 and 2, what do you think the LPN/LVN should do FIRST? It is within the LPN/LVN’s scope of practice to recognize the client’s symptoms as hypoglycemia and offer the client fruit juice. They physician should be notified if the symptoms do not resolve.
This is an example of a priority question. The topic (hypoglycemia) and the action (choosing a priority action) is also from the PN Practice Analysis. This type of question is important on the NCLEX-PN® examination.