The nurse may notice which clinical manifestation in the pediatric client diagnosed with type 1 diabetes mellitus?

Choice A reason: This statement is false. Edema is a sign of fluid overload, not fluid deficit. Edema occurs when fluid accumulates in the interstitial space due to increased capillary hydrostatic pressure or decreased plasma oncotic pressure. Edema is more common in patients with heart failure, liver disease, or kidney disease¹.

Choice B reason: This statement is false. Skin turgor is a measure of skin elasticity and hydration. It can be affected by factors such as age, skin condition, and ambient temperature. Skin turgor is not a reliable indicator of fluid balance, as it can be normal in patients with mild to moderate hypovolemia².

Choice C reason: This statement is false. Urine output is a measure of kidney function and fluid excretion. It can be influenced by factors such as fluid intake, diuretics, hormones, and renal diseases. Urine output is not a sensitive indicator of fluid balance, as it can be normal or even increased in patients with hypovolemia due to compensatory mechanisms.

Choice D reason: This statement is true. Daily weight is a measure of body mass and fluid status. It can reflect changes in fluid balance more accurately than other methods, as long as the weight is measured at the same time, on the same scale, and with the same clothing each day. A decrease in weight can indicate fluid loss due to hypovolemia.

Choice A reason: Urine dipstick for glucose is not a reliable test to evaluate the effectiveness of treatment for type 2 diabetes. Urine glucose testing can only detect glucose in the urine when the blood glucose level is very high, above the renal threshold of 180 mg/dL. Urine glucose testing does not reflect the average blood glucose level over time, and can be affected by factors such as hydration, medication, and urinary tract infections.

Choice B reason: Fasting blood glucose is a test that measures the blood glucose level after an overnight fast of at least 8 hours. Fasting blood glucose is a useful test to diagnose diabetes, but it is not the best test to evaluate the effectiveness of treatment for type 2 diabetes. Fasting blood glucose only reflects the blood glucose level at one point in time, and can vary depending on the time of day, the amount and type of food eaten, and the activity level.

Choice C reason: Oral glucose tolerance is a test that measures the blood glucose level before and after drinking a solution containing 75 g of glucose. Oral glucose tolerance is another test that can diagnose diabetes, but it is not the most convenient or accurate test to evaluate the effectiveness of treatment for type 2 diabetes. Oral glucose tolerance requires the patient to fast for at least 8 hours, drink the glucose solution, and have blood samples taken at 0, 30, 60, 90, and 120 minutes. Oral glucose tolerance can also be influenced by factors such as stress, illness, medication, and menstrual cycle.

Choice D reason: Glycosylated hemoglobin (Hemoglobin A1C) is a test that measures the percentage of hemoglobin that has glucose attached to it. Hemoglobin is a protein in the red blood cells that carries oxygen. Red blood cells have a lifespan of about 120 days, so the hemoglobin A1C test reflects the average blood glucose level over the past 2 to 3 months. Hemoglobin A1C is the best test to evaluate the effectiveness of treatment for type 2 diabetes, as it shows how well the blood glucose level has been controlled over time, and is not affected by factors such as fasting, food intake, or daily fluctuations.