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?
Skipped eating lunch.
Incorrectly administered too much insulin.
Had a cold and ear infection for the past two days.
Ate an extra peanut butter sandwich before gym class.
None
None
The Correct Answer is B
Rationale for A: Skipping a meal can lead to elevated blood glucose levels, but it typically would not result in ketoacidosis unless accompanied by insulin deficiency.
Rationale for B: Administering too much insulin would lead to hypoglycemia rather than ketoacidosis, as it would lower blood glucose levels and prevent the production of ketones.
Rationale for C: Illness, such as a cold and ear infection, can increase insulin resistance and metabolic stress, leading to elevated blood glucose levels and precipitating diabetic ketoacidosis.
Rationale for D: Eating an extra sandwich before gym class would generally increase blood glucose levels but would not directly lead to ketoacidosis unless there was inadequate insulin to manage the increased intake.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This is the group of children that the PN should screen for scoliosis because they are at the highest risk of developing this condition. Scoliosis is a lateral curvature of the spine that usually occurs during the growth spurt before puberty. Girls are more likely than boys to have scoliosis, and the condition tends to worsen during adolescence.
Correct Answer is C
Explanation
The correct answer is c. Raise the side rails and notify the family to come and stay until the client is reoriented and cooperative. This intervention ensures the client’s safety and provides familiar support, which can help reorient and calm the client.
Choice A reason: Administering a prescribed narcotic antagonist assumes the agitation is due to narcotic accumulation without evidence. This could lead to unnecessary medication administration.
Choice B reason: Requesting restraints should be a last resort due to the risks of injury and increased agitation. Restraints can also lead to further complications.
Choice C reason: Raising the side rails and involving the family provides immediate safety and emotional support, which can help reorient the client. Familiar faces can be very calming and reassuring.
Choice D reason: Instructing a UAP to check on the client every 15 minutes lacks the immediate family support that can help reorient the client. Continuous monitoring is important, but family involvement is more effective.
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