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 C

Explanation

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects communication, social interaction, and behavior. When planning care for a child with ASD, it's important to consider their individual needs and strengths.

A) Allow for adjustment of rules to correlate with the child's behavior:

Children with ASD often benefit from consistent routines and clear expectations. Adjusting rules based on behavior might confuse the child and undermine the structure they rely on for understanding their environment.

B) Allow for imaginative play with peers without supervision:

Children with ASD can struggle with social interactions and may need guidance to engage in play with peers successfully. Unsupervised imaginative play might lead to challenges or misunderstandings, making supervision and support important.

C) Provide a flexible schedule that adjusts to the child's interests:

This is a crucial intervention. Many children with ASD find comfort in routines, but rigidity can be detrimental. A flexible schedule that incorporates the child's interests can enhance engagement, motivation, and learning. It provides structure while accommodating the child's preferences.

D) Establish a reward system for positive behavior:

Reward systems can be effective for motivating positive behaviors in children with ASD. Visual cues and rewards are often helpful in reinforcing desired behaviors. This intervention can encourage appropriate social interactions and communication.

A. “I will continue to check his blood sugar two times every day.” B. "I will report a change in her breathing or any signs of confusion.” C. “I will encourage her to drink half a cup of water or sugar-free fluid every 30 minutes” D. "I will notify the doctor if her temperature is not controlled by acetaminophen”

Correct Answer is A

Explanation

A. "I will continue to check his blood sugar two times every day."

Correct Explanation: This statement indicates a need for further instruction.

Explanation: A child with type 1 diabetes requires frequent blood sugar monitoring, especially during illness. Checking blood sugar only twice a day is not sufficient, especially when the child has an upper respiratory infection. Illness can impact blood sugar levels, so more frequent monitoring is necessary to ensure proper diabetes management.

B. "I will report a change in her breathing or any signs of confusion."

Incorrect Explanation: This statement shows awareness of potential complications and the need to monitor for them.

Explanation: Children with type 1 diabetes are at risk of diabetic ketoacidosis (DKA) when they are sick. Changes in breathing patterns and signs of confusion are symptoms of DKA. Reporting these symptoms is important, as it could indicate a serious diabetic complication.

C. "I will encourage her to drink half a cup of water or sugar-free fluid every 30 minutes."

Incorrect Explanation: This statement demonstrates proper fluid management, especially during illness.

Explanation: Encouraging the child to stay hydrated with sugar-free fluids is essential, particularly when the child has an upper respiratory infection. Proper hydration helps prevent dehydration, which can be more concerning for a child with diabetes.

D. "I will notify the doctor if her temperature is not controlled by acetaminophen."

Incorrect Explanation: This statement shows an understanding of the importance of managing fever in a child with diabetes.

Explanation: Children with diabetes can experience difficulty managing blood sugar levels when they're sick. Fever can exacerbate this issue. Using acetaminophen to control fever is appropriate, and notifying the doctor if fever persists is a responsible action.

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