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A child is brought into the emergency department with vomiting, drowsiness, and blowing respirations. The child's parent reports that the symptoms have been progressing throughout the day. The nurse suspects diabetic ketoacidosis (DKA). Which action should the nurse take first in the management of DKA?
- A. Give prescribed antiemetics.
- B. Begin fluid replacements.
- C. Administer prescribed dose of insulin.
- D. Administer bicarbonate to correct acidosis.
Correct Answer: B
Rationale: In DKA, correcting dehydration and electrolyte imbalances with fluid replacement is the first priority to stabilize the patient before addressing hyperglycemia with insulin. Antiemetics and bicarbonate are secondary, and insulin requires a physician's order.
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A client asks why pancreas transplantation is not an option offered to all insulin-dependent clients with diabetes. Which is the best response by the nurse?
- A. Type 1 diabetes can be managed in most clients with insulin.
- B. Pancreas transplant is becoming more common.
- C. There is a long waiting list to receive a new pancreas.
- D. For every transplant, two deceased donors are needed.
Correct Answer: A
Rationale: Type 1 diabetes is manageable with insulin, and the risks of lifelong immunosuppression from transplantation often outweigh benefits. Pancreas transplants are not increasingly common, waiting lists are not the primary issue, and only one donor is needed.
A client with diabetes comes to the clinic for a follow-up visit. The nurse reviews the client's glycosylated hemoglobin test results. Which result would indicate to the nurse that the client's blood glucose level has been well controlled?
- A. 5.50%
- B. 6.50%
- C. 8.80%
- D. 7.80%
Correct Answer: A
Rationale: A glycosylated hemoglobin level below 7% (e.g., 5.5%) indicates good blood glucose control over the past 2-3 months. Levels of 7.5% or higher (e.g., 7.8%, 8.8%) suggest suboptimal control, with 7% correlating to an average blood glucose of 150 mg/dL.
A client newly diagnosed with type 1 diabetes asks the nurse why injection site rotation is important. What is the nurse's best response?
- A. Avoid infection.
- B. Promote absorption.
- C. Minimize discomfort.
- D. Prevent muscle destruction.
Correct Answer: B
Rationale: Rotating injection sites prevents lipodystrophy (fat buildup or breakdown), ensuring consistent insulin absorption. While infection and discomfort are concerns, they are not the primary reasons. Insulin is not injected into muscle, so muscle destruction is irrelevant.
On initial nursing rounds, the diabetic client reports 'not feeling well.' Later, the nurse finds the client to be diaphoretic and in a stuporous state. Which is the immediate action taken by the nurse?
- A. Call the physician.
- B. Obtain a glucometer reading.
- C. Administer fruit juice.
- D. Start an IV of dextrose.
Correct Answer: B
Rationale: A glucometer reading is critical to differentiate between hypoglycemia and diabetic ketoacidosis in a stuporous diabetic client. Administering juice or IV dextrose without confirming hypoglycemia risks worsening hyperglycemia, and calling the physician is secondary to obtaining a glucose level.
The client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding as the explanation for the inspection of feet?
- A. Autonomic neuropathy
- B. Retinopathy
- C. Sensory neuropathy
- D. Nephropathy
Correct Answer: C
Rationale: Sensory neuropathy from poor glucose control reduces foot sensation, increasing injury risk. Regular foot inspections detect issues early. Autonomic neuropathy affects organs, retinopathy affects eyes, and nephropathy affects kidneys, not directly related to foot injuries.