A nurse is providing teaching to a school-age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates an understanding of the teaching?
“I should not take my regular insulin when I am sick.”.
“I can store unopened bottles of insulin in the freezer.”.
“My morning blood glucose should be between 90 and 130.”.
“I should eat a snack half an hour before playing soccer.”.
The Correct Answer is C
Choice A rationale
Regular insulin should not be withheld during illness. When a person with type 1 diabetes is sick, their body may produce more glucose due to stress and infection, leading to hyperglycemia. Therefore, it is crucial to continue taking insulin to manage blood glucose levels effectively.
Choice B rationale
Insulin should not be stored in the freezer. Freezing insulin can cause it to degrade and lose its effectiveness. Insulin should be stored in the refrigerator at a temperature between 2°C and 8°C (36°F and 46°F) until it is opened. Once opened, it can be kept at room temperature for a specified period, usually around 28 days.
Choice C rationale
The target range for morning blood glucose levels in children with type 1 diabetes is typically between 90 and 130 mg/dL. Maintaining blood glucose within this range helps to prevent both hyperglycemia and hypoglycemia, ensuring better overall diabetes management and reducing the risk of complications.
Choice D rationale
Eating a snack before physical activity is important for children with type 1 diabetes to prevent hypoglycemia. Physical activity can lower blood glucose levels, so having a snack that contains carbohydrates can help maintain stable blood glucose levels during exercise.
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Correct Answer is B
Explanation
Choice A rationale
Encouraging deep breaths hourly can help prevent atelectasis and improve oxygenation, but it is not the priority in managing a vaso-occlusive crisis. The primary issue in a vaso-occlusive crisis is the blockage of blood flow due to sickled cells, leading to pain and potential organ damage. While deep breathing exercises are beneficial, they do not directly address the underlying cause of the crisis.
Choice B rationale
Maintaining fluids through an intravenous line is crucial in managing a vaso-occlusive crisis. Hydration helps to reduce blood viscosity, which can prevent further sickling of red blood cells and improve blood flow. Adequate hydration is essential to minimize the risk of complications such as stroke, acute chest syndrome, and organ damage. Therefore, maintaining IV fluids is a priority intervention in this scenario.
Choice C rationale
Beginning active range-of-motion exercises can help prevent joint stiffness and maintain mobility, but it is not the priority during an acute vaso-occlusive crisis. The primary focus should be on managing pain, ensuring adequate hydration, and preventing complications. Once the acute phase is managed, physical therapy and exercises can be introduced to support long- term health and mobility.
Choice D rationale
Seeing that the child ingests a protein-rich diet is important for overall health and growth, especially in children with chronic conditions like sickle cell anemia. However, during an acute vaso-occlusive crisis, the immediate priority is to manage pain, ensure hydration, and prevent complications. Nutritional support can be addressed once the acute crisis is under control.
Correct Answer is B
Explanation
Choice A rationale
Montelukast is a leukotriene receptor antagonist used for long-term control and prevention of asthma symptoms. It is not a rescue medication and does not provide immediate relief during an acute asthma attack. Montelukast works by reducing inflammation and preventing bronchoconstriction, but its effects are not rapid enough to address the immediate needs of a patient experiencing an acute asthma attack.
Choice B rationale
Albuterol is a short-acting beta-agonist (SABA) that provides rapid bronchodilation and is the first-line treatment for acute asthma attacks. It works by relaxing the smooth muscles in the airways, leading to quick relief of bronchospasm and improved airflow. Administering albuterol promptly can help alleviate symptoms and prevent the progression of an asthma attack, making it the priority medication in this scenario.
Choice C rationale
Fluticasone is an inhaled corticosteroid used for long-term control of asthma. It helps reduce inflammation in the airways and prevent asthma symptoms but is not effective as a rescue medication during an acute asthma attack. Inhaled corticosteroids are typically used as part of a daily maintenance regimen to manage chronic asthma and prevent exacerbations.
Choice D rationale
Budesonide is another inhaled corticosteroid used for long-term asthma control. Like fluticasone, it helps reduce airway inflammation and prevent asthma symptoms but is not suitable for immediate relief during an acute asthma attack. Inhaled corticosteroids are important for managing chronic asthma but do not provide the rapid bronchodilation needed in an emergency situation.