A client with a history of type 1 diabetes mellitus (DM) and asthma is readmitted to the unit for the third time in two months with a current fasting blood sugar (FBS) is 325 mg/dL (18 mmol/L). The client describes to the nurse of not understanding why the blood glucose level continues to be out of control. Which intervention(s) should the nurse implement? (Select all that apply.)

Have the client demonstrate technique used to monitor blood glucose levels.

Evaluate the client's asthma medications that can elevate the blood glucose.

Ask the client if they want a different manufacturer's glucose monitoring device.

Understand the client's daily routine

Ensuring the client uses a new insulin needle for each administration

Answer and Explanation

Correct Answer : A,B,D,E

A) Correct - Demonstrating the technique used to monitor blood glucose levels is crucial.

Incorrect technique can lead to inaccurate readings, impacting insulin dosing decisions and blood sugar control.
B) Correct - Some asthma medications, like corticosteroids, can elevate blood glucose levels.

Evaluating the client's asthma medications is essential as they can contribute to fluctuations in blood sugar levels.
C)   Incorrect- Asking the client if they want a different manufacturer's glucose monitoring device is not helpful, because it does not address the underlying causes of the poor glycemic control. The client may also perceive this as a lack of confidence in their ability to manage their diabetes or as a criticism of their choice of device. The nurse should focus on educating the client on how to use their current device correctly and consistently, rather than suggesting a change that may not be necessary or feasible.
D)   Correct - Understanding the client's daily routine helps identify factors influencing blood glucose control, such as meal timing, activity level, and stress. This information aids in creating a personalized diabetes management plan.
E)   Correct - Ensuring the client uses a new insulin needle for each administration is important for preventing infection and complications. Reusing needles can affect injection site health and insulin absorption.

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Correct Answer is ["A","B","D"]

Explanation

A) Correct - Providing contact information for community resources is important as it ensures that parents have access to support and information beyond the hospital setting.

B) Correct - Offering information about pool safety is relevant, especially considering that the child experienced a submersion injury. This education can help prevent future accidents.
C) Incorrect - While discussing child neglect is important, it may not be the most appropriate time to bring up potential charges. The immediate focus should be on education and support.
D) Correct - Informing parents about when to follow up with the child's pediatrician ensures continuity of care and monitoring of the child's condition after discharge.
E) Incorrect - Instructions on how to access long-term home care may not be necessary if the child's condition does not warrant it. This option can be excluded based on the information provided.
F) Incorrect - Assessing the parent's coping skills is important, but it is not part of pre- discharge education. Education related to the child's condition and safety is more pertinent.

A. Skipped eating lunch. B. Incorrectly administered too much insulin. C. Had a cold and ear infection for the past two days. D. Ate an extra peanut butter sandwich before gym class. E. None F. None

Correct Answer is C

Explanation

A. Skipped eating lunch would more likely cause hypoglycemia rather than diabetic ketoacidosis (DKA). When a person with type 1 diabetes skips a meal but still takes insulin, blood glucose levels drop, leading to hypoglycemia, not the elevated glucose and ketone production seen in DKA.

B. Incorrectly administered too much insulin would also result in hypoglycemia rather than DKA. Administering excessive insulin causes blood glucose levels to fall too low, which does not trigger the fat breakdown and ketone production that characterize DKA.

C. Had a cold and ear infection for the past two days is the most likely cause of diabetic ketoacidosis. Illness and infection cause the body to release stress hormones such as cortisol and adrenaline, which increase blood glucose levels and counteract insulin. In type 1 diabetes, insufficient insulin leads to hyperglycemia, fat breakdown for energy, and the production of ketones, resulting in DKA.

D. Ate an extra peanut butter sandwich before gym class would not cause DKA. Consuming extra food may raise blood glucose temporarily, but it would not lead to the severe insulin deficiency and ketone production seen in DKA, especially if the adolescent took insulin as prescribed.

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","B","D"]

Explanation

An adolescent who was diagnosed with type 1 diabetes mellitus at the age of 9, is admitted to the hospital in diabetic ketoacidosis. Which occurrence is the most likely cause of the ketoacidosis?

Correct Answer is C

Explanation

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