A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. Which of the following findings should the nurse identify as a manifestation of type 1 diabetes?

Rationale:
A. Distended neck veins: Distended neck veins are typically associated with fluid volume excess, such as in heart failure or hypervolemia. In hypovolemia, the central venous pressure is low, often resulting in flat or collapsed neck veins due to the decreased circulating blood volume and reduced venous return.

B. Rapid pulse rate: Tachycardia is a key early sign of hypovolemia, as the heart attempts to compensate for decreased blood volume by increasing the heart rate to maintain adequate cardiac output. This compensatory mechanism helps preserve perfusion to vital organs during volume loss.

C. Urine output 45 mL/hr: A urine output of 45 mL/hr is considered adequate and within the normal range for an adult. In hypovolemia, renal perfusion typically decreases, often leading to oliguria (urine output less than 30 mL/hr), which would be a more specific indicator of fluid deficit.

D. Decreased respiratory rate: Hypovolemia generally triggers an increase in respiratory rate (tachypnea) as a compensatory response to improve oxygen delivery and perfusion. A decreased respiratory rate would be unusual and not characteristic of a volume-depleted state.

Rationale:
A. Contact the provider who will be performing the procedure: It is the provider’s legal and ethical responsibility to explain the procedure, including its purpose, risks, benefits, and alternatives. If the client does not understand, the nurse must contact the provider to clarify and ensure informed consent is valid.

B. Instruct the client's spouse to sign the consent form: A spouse may only sign the form if the client is legally unable to do so. If the client is competent but lacks understanding, they should not sign until they receive adequate information from the provider.

C. Read the consent form to the client using words the client will understand: While the nurse can clarify terms, reading or paraphrasing the consent form does not replace the provider’s obligation to explain the procedure fully and answer questions.

D. Provide teaching about the surgical procedure for the client: Nurses may reinforce information, but only the provider can give the detailed explanation required for informed consent. Providing full procedural teaching falls outside the nurse’s scope for consent purposes.