The nurse is providing education to a school-aged child recently diagnosed with type 1 diabetes mellitus (DM). Which item will the nurse include in the teaching plan regarding sick day management?
Holding the prescribed dose of insulin.
Encouraging exercise.
Monitoring blood glucose every 12 hours.
Monitoring for ketones after each void.
The Correct Answer is D
A. Insulin should never be skipped during illness. In fact, insulin needs may increase during sick days due to stress and elevated blood glucose levels. Holding insulin can lead to hyperglycemia and diabetic ketoacidosis (DKA).
B. During illness, especially when the child has fever, vomiting, or hyperglycemia, strenuous exercise is not recommended because it can worsen dehydration and stress the body. Light activity may be acceptable if the child feels well, but exercise is not a priority during sick day management.
C. During illness, blood glucose can fluctuate significantly. Monitoring only every 12 hours is insufficient. Blood glucose should be checked frequently (every 3–4 hours or more as needed) to guide insulin dosing and prevent complications.
D. Sick days increase the risk of DKA, especially if blood glucose is elevated. The nurse should teach the child and family to monitor urine for ketones after each void or check blood ketones if available. Early detection of ketones allows prompt intervention, such as adjusting insulin, increasing fluid intake, and seeking medical care if necessary, to prevent severe DKA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Atopic dermatitis (eczema) is not caused by bacteria, so antibiotics are generally not indicated unless there is a secondary bacterial infection. Routine antibiotic use is not part of standard eczema management.
B. Antihistamines can be used to relieve itching and improve sleep in children with atopic dermatitis, especially during flare-ups. This is part of symptom management and helps prevent scratching, which can worsen the condition or lead to infection.
C. Liquid nitrogen (cryotherapy) is used for wart removal or certain skin lesions, not for atopic dermatitis. Eczema management focuses on skin hydration, avoiding triggers, and controlling inflammation, not lesion removal with cryotherapy.
D. Warm compresses can irritate sensitive skin and worsen itching or inflammation. Cool, wet compresses are recommended for soothing acute flare-ups of atopic dermatitis.
Correct Answer is D
Explanation
A. While anorexia, nausea, and vomiting are common in diabetic ketoacidosis (DKA) due to metabolic acidosis and electrolyte imbalances, hypertension is not typical. In fact, hypotension is more common in DKA because of severe dehydration caused by osmotic diuresis (excessive urination to remove glucose). Thus, hypertension would not be an expected finding.
B. Cold, clammy skin and irritability are classic signs of hypoglycemia, not DKA. Hypoglycemia triggers the sympathetic nervous system, causing diaphoresis, pallor, and agitation, which are distinct from the hyperglycemic and dehydrated state seen in DKA.
C. Sweating and tremors are also indicative of hypoglycemia. In DKA, the body is in a hyperglycemic, dehydrated state, often presenting with warm, dry skin due to fluid loss, not the cool, clammy skin seen in low blood glucose episodes.
D. Fruity or acetone-smelling breath results from ketone accumulation due to fat metabolism in the absence of sufficient insulin. Confusion and altered mental status are consequences of dehydration, hyperglycemia, and electrolyte imbalances, particularly sodium and potassium disturbances. Other hallmark DKA signs include polyuria, polydipsia, abdominal pain, vomiting, tachypnea (Kussmaul respirations), and lethargy. Prompt recognition of these manifestations is critical to initiate fluid replacement, insulin therapy, and electrolyte correction to prevent life-threatening complications.
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