A nurse is teaching a school-age child who has type 1 diabetes mellitus and his parents about illness management. Which of the following instructions should the nurse include?

"Limit fluid intake during meal time."

"Notify the provider if blood glucose levels are over 350 milligrams/decilitre

Test the urine for ketones.

"Withhold insulin dose if feeling nauseous"

Answer and Explanation

The Correct Answer is C

A) "Limit fluid intake during mealtime":

Limiting fluid intake during meals is not a standard practice for managing type 1 diabetes. Proper hydration is important for overall health, and fluids should be consumed as needed.

B) "Notify the provider if blood glucose levels are over 350 milligrams/deciliter":

Blood glucose levels over 350 mg/dL can indicate hyperglycemia, which requires prompt attention. High blood glucose levels can lead to complications if not addressed promptly. Contacting the healthcare provider is an appropriate step. However, consistent Blood Glucose Levels Above 240 mg/dL (13.3 mmol/L) or presence of symptoms like frequent urination, thirst, blurry vision, or fatigue) are concerning. The client should have contacted the health care provider by this point.

C) "Test the urine for ketones":

Testing urine for ketones is an important instruction. Ketones are produced when the body breaks down fat for energy, often in the absence of sufficient insulin. High ketone levels can indicate diabetic ketoacidosis (DKA), a serious complication. Regular ketone testing, especially during illness or high blood glucose levels, helps monitor for DKA.

D) "Withhold insulin dose if feeling nauseous":

This instruction is not accurate. Nausea could be a sign of various conditions, including illness. Insulin should not be withheld without consulting a healthcare provider. Managing insulin doses appropriately is crucial to maintaining blood glucose control

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Correct Answer is A

Explanation

A. "My son might complain of feeling shaky when he has a low blood glucose level."

Explanation: Correct Choice. Shaking or feeling shaky is a common symptom of low blood glucose levels, also known as hypoglycemia. When blood sugar drops too low, the body releases adrenaline, causing shaking or trembling. This response is indicative of an understanding of hypoglycemia symptoms.

B. "My son might have nausea and vomiting with hypoglycemia."

Explanation: Nausea and vomiting are not typical symptoms of hypoglycemia (low blood sugar). They are more commonly associated with hyperglycemia (high blood sugar) or other conditions. This statement is not accurate in the context of hypoglycemia.

C. "Sweating can occur with hyperglycemia."

Explanation: Sweating is more commonly associated with hypoglycemia (low blood sugar) rather than hyperglycemia (high blood sugar). When blood sugar levels drop too low, the body can respond with sweating as part of the adrenaline release. Sweating is not a typical symptom of hyperglycemia.

D. "The onset of low blood glucose usually occurs slowly."

Explanation: The onset of low blood glucose (hypoglycemia) can vary. It can occur suddenly, especially if the individual takes too much insulin or diabetes medication, leading to a rapid drop in blood sugar. The correct understanding is that the onset of low blood glucose can be rapid and not always slow.

A. Document intake and output. B. Administer antibiotics when available C. Reduce environmental stimuli D. Maintain seizure precaution

Correct Answer is B

Explanation

A) Document intake and output:

Documenting intake and output is an important nursing task, but it is not the top priority in a suspected case of bacterial meningitis. Timely administration of antibiotics to treat the infection takes precedence over documentation of intake and output.

B) Administer antibiotics when available.

Explanation:

Bacterial meningitis is a serious and potentially life-threatening infection of the membranes covering the brain and spinal cord. Rapid administration of antibiotics is crucial to effectively treat the infection and prevent its spread. Delay in antibiotic administration can lead to worsening symptoms and complications. Therefore, getting the appropriate antibiotics to the child as soon as they are available is the nurse's priority.

C) Reduce environmental stimuli:

Reducing environmental stimuli can be helpful in managing symptoms and providing comfort to the child with meningitis, but it is not the priority action. The immediate concern in a suspected case of bacterial meningitis is to treat the infection.

D) Maintain seizure precaution:

While maintaining seizure precautions is important, especially if the child has a history of seizures, it is not the top priority in a suspected case of bacterial meningitis. Administering antibiotics to treat the infection and prevent its progression is the primary concern.

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A nurse is teaching a school-age child who has type 1 diabetes mellitus and his parents about illness management. Which of the following instructions should the nurse include?

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