A client with a history of schizophrenia, and drug and alcohol abuse is admitted to the hospital for hepatitis. The nurse should contact the healthcare provider before implementing which prescription?

Choice A reason: Going to the ER for glucose is unnecessary unless hypoglycemia or ketoacidosis is confirmed. Type 1 diabetes with nausea risks hyperglycemia from stress hormones like cortisol. Monitoring glucose and fluids manages the condition at home, preventing escalation unless severe symptoms arise, making this instruction premature.

Choice B reason: Drinking regular cola introduces high sugar, risking hyperglycemia in type 1 diabetes, where insulin deficiency impairs glucose uptake. Stress from illness elevates glucose via glucagon. Monitoring with non-sugar fluids prevents dehydration and ketoacidosis, making this advice dangerous and ineffective for diabetes management.

Choice C reason: Monitoring blood glucose and drinking fluids is critical in type 1 diabetes during illness. Nausea reduces intake, and stress hormones raise glucose, risking ketoacidosis. Frequent checks guide insulin adjustments, and fluids prevent dehydration, maintaining metabolic stability, addressing the physiological needs of insulin deficiency and infection.

Choice D reason: Avoiding insulin risks diabetic ketoacidosis, as type 1 diabetes requires basal insulin despite nausea. Illness increases glucose via stress hormones, even without food. Monitoring allows tailored dosing, preventing hyperglycemia, making this instruction harmful, as it ignores ongoing insulin needs for metabolic control.

Choice A reason: Connecting to suction is inappropriate, as “coffee ground” drainage indicates upper GI bleeding, likely from an ulcer. Suction could worsen bleeding by traumatizing the site. Clamping and notifying the provider ensure assessment, preventing further hemorrhage or complications like perforation in this critical scenario.

Choice B reason: “Coffee ground” drainage suggests oxidized blood from upper GI bleeding (e.g., gastritis). Clamping prevents irritation or bleeding exacerbation, and contacting the provider ensures urgent evaluation, possibly via endoscopy or proton pump inhibitors, addressing the bleeding source to stabilize the client and prevent shock.

Choice C reason: Removing and reinserting the tube risks further trauma to the bleeding site, as “coffee ground” drainage indicates active hemorrhage. Repeated insertion may dislodge clots, worsening bleeding. Clamping and notifying the provider prioritize safety, allowing diagnostic and therapeutic interventions for the underlying cause.

Choice D reason: High continuous suction is contraindicated, as “coffee ground” drainage signals GI bleeding, and aggressive suction could dislodge clots, increasing hemorrhage. Clamping and contacting the provider ensure controlled management, preventing complications like hypovolemic shock, making this action harmful and inappropriate.