At the beginning of the school year, in addition to developing a diabetic management plan for the

student, it is most important for the school nurse to:

confer with the student, his family, and his health-care provider regarding interventions for blood sugar
fluctuations.

review with the student and his family current recommended nursing interventions for treating and
monitoring episodes of diabetic ketoacidosis.

ensure that the student's family understands the etiology of diabetes as a pancreatic cell abnormality
that is initiated by a viral or autoimmune disorder.

discuss the pathology and physiology of diabetes and what the future might hold for the student in
relation to the disease.

Answer and RationaleAnswer expanded

Correct Response: A.

Students with type 1 diabetes require a thorough assessment of their health needs and a specific health
plan that addresses schedules and procedures for blood glucose monitoring and/or carbohydrate
monitoring, meal and snack considerations, treatment and medication protocols, and steps for
responding to fluctuations in blood sugar levels. In addition to reviewing medical and educational
records, it is essential for the school nurse to interview and consult with the student and his or her
parents/guardians to learn about the student's diabetes regimen, physician recommendations, and how
and when the family and student monitor the student's glucose levels. The process of developing
interventions may involve obtaining materials and medical supplies necessary for performing diabetes
care tasks from the parents/guardians, identifying the target range for blood glucose levels
recommended by the student's physician, documenting and sending blood glucose levels home to be
assessed by parents/guardians, notifying parents/guardians immediately of extremely high or low
glucose levels, and agreeing on specific interventions for diabetic emergencies in school settings.

The school nurse checks the emergency care plan (ECPE C P) on file that outlines steps to take if the
student exhibits signs of hypoglycemia. According to current standards of school nursing practice, which
of the following actions is most appropriate to take first in response to a hypoglycemic reaction in a
conscious student?

administering warm clear fluids or diet soda in sips

administering a quickly digestible protein source and monitoring the student for 15 minutes

administering insulin according to the dose specified in the student's insulin schedule

administering glucose tabs or a fast-acting carbohydrate such as juice, cake gel, or candy
Answer and RationaleAnswer expanded

Correct Response: D.

A hypoglycemic (low blood sugar) reaction can occur in a conscious student who has type 1 diabetes
when the student's insulin level is too high, when the student misses or delays food intake, or when the
student over-exercises. In these cases, the school nurse should administer a source of sugar, in the form
of glucose tabs or gel/icing, or simple carbohydrates such as juice, regular soda, candy, or honey. After
10 or 15 minutes and once symptoms have been alleviated, the school nurse may provide the student
with a protein and carbohydrate snack (e.g., cheese and crackers).

The school nurse would like to collaborate with the student's middle school teachers in managing his
health-care needs. Which of the following strategies is the most appropriate way of involving teachers in
a health care plan for this student?

suggesting to teachers that they buy and store healthful snacks in the classroom in case of an acidosis or
hypoglycemic reaction

increasing teachers' understanding of diabetes, signs of early insulin reaction, and what to do if
symptoms appear

asking teachers to designate a private corner or place in the classroom where the student can test and
record his blood levels

developing a protocol and training course for teacher administration of medication in emergencies

Answer and RationaleAnswer expanded

Correct Response: B.

Teachers who have students with diabetes in their classes should have basic knowledge about the
disease and how to assist students in managing the disease. The school nurse can coordinate
conferences with the student who has diabetes and the student's parents/guardians, teachers, and
principal to discuss the student's health and develop a care plan for the student. The school nurse
should ensure that teachers are familiar with the supplies students may need during the school day
(e.g., testing strips, insulin pen, lancets, blood glucose meter, glucose tablets, juice boxes), signs and
symptoms of low and high blood sugar, action plans for hypoglycemia and hyperglycemia, and
communication and response considerations (e.g., contacting parents/guardians in the event of a
diabetic emergency, never allowing a student who is experiencing low blood sugar to walk to the nurse’s
office alone). There are also many professional resources that can support a school nurse's efforts in
educating students about diabetes, including downloadable handouts from the Web sites of national
diabetes organizations.