A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition?

Choice A reason: I will need to take medication by mouth until my blood sugar is within normal limits again is an incorrect statement that indicates the need for further teaching. Type 1 diabetes mellitus (DM) is a condition where the pancreas does not produce any insulin, a hormone that helps the cells use glucose for energy. Patients with type 1 DM need to take insulin injections or use an insulin pump for life to replace the missing hormone. Oral medications for diabetes are not effective for type 1 DM, as they work by stimulating the pancreas to produce more insulin or by increasing the sensitivity of the cells to insulin.

Choice B reason: If I get the flu, the dose of my insulin may need to be altered to control my blood glucose is a correct statement that shows understanding of the disease process. Illnesses such as the flu can increase the blood glucose level, as the body releases hormones that counteract the effects of insulin. Patients with type 1 DM may need to adjust their insulin dose, monitor their blood glucose more frequently, and check for ketones in their urine or blood when they are sick. Ketones are acidic substances that are produced when the body breaks down fat for energy, and can lead to a serious complication called diabetic ketoacidosis.

Choice C reason: I will monitor my blood glucose to help determine whether my medication is working as anticipated is another correct statement that demonstrates knowledge of the disease management. Blood glucose monitoring is an essential part of diabetes care, as it helps the patients and the health care providers to evaluate the effectiveness of the insulin therapy, the diet, and the exercise plan. Blood glucose monitoring also helps to prevent or detect hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar), and to adjust the insulin dose accordingly.

Choice D reason: The things that I eat may impact the dose of my medication used to control my blood glucose is also a correct statement that reflects awareness of the disease implications. The amount and type of carbohydrates that the patients eat can affect their blood glucose level, as carbohydrates are the main source of glucose in the diet. Patients with type 1 DM need to balance their insulin dose with their carbohydrate intake, and follow a consistent and healthy eating pattern. They may also use carbohydrate counting, a method of estimating the grams of carbohydrates in the foods they eat, to help them plan their meals and snacks.

Choice A reason: This statement is false. Drinking more fluids in the late evening can cause nocturia, which is the need to urinate frequently at night. This can disrupt the sleep cycle and increase the risk of falls.

Choice B reason: This statement is true. Dry mouth is a sign of dehydration and indicates the need for more fluid intake. Older adults may have reduced thirst sensation and may not drink enough fluids throughout the day.

Choice C reason: This statement is false. Caffeine is a diuretic, which means it increases urine output and can worsen dehydration. Confusion is a symptom of dehydration and requires immediate medical attention.

Choice D reason: This statement is false. Feeling full is not a reliable indicator of hydration status. Older adults may have decreased appetite and gastric motility, which can make them feel full even when they are dehydrated.