A nurse is caring for a preschool-age child who is postoperative following a tonsillectomy and is clearing her throat frequently. Which of the following actions should the nurse take first?

A. Nephrotic syndrome typically presents with edema, proteinuria, hypoalbuminemia, and hyperlipidemia, rather than the symptoms described in the scenario.
B. Renal scarring can occur as a complication of untreated or recurrent urinary tract infections (UTIs), particularly pyelonephritis. The presence of fever and lethargy in the child, along with the history of decreased appetite, raises concerns for a urinary tract infection that could lead to renal scarring if left untreated.
C. Polycystic kidney disease typically presents later in life and is not typically associated with acute febrile illness in a 1-year-old toddler.
D. While acute glomerulonephritis can occur following certain infections such as streptococcal infections, it is less commonly associated with fever and lethargy compared to pyelonephritis.

E. Pyelonephritis is a bacterial infection of the kidneys commonly associated with fever and lethargy, especially in young children. The fever and lethargy reported by the parent, along with the urine sample obtained, suggest a concern for pyelonephritis.

Rationale:

A. Storing opened vials of insulin for up to 60 days is incorrect. Insulin should be discarded after the manufacturer's recommended expiration date or within 28 days after opening, whichever comes first.

B. Physical therapy is not typically indicated as part of routine care for adolescents with type 1 diabetes mellitus. However, regular physical activity is encouraged for overall health and blood sugar management.

C. Consulting with a nutritionist is important for adolescents with type 1 diabetes mellitus to receive individualized meal planning guidance, carbohydrate counting education, and dietary recommendations to help manage blood sugar levels.

D. Monitoring capillary blood glucose daily is essential for adolescents with type 1 diabetes mellitus, but it is not the only recommendation. Comprehensive diabetes management includes multiple aspects such as insulin therapy, dietary modifications, physical activity, and regular monitoring of blood glucose levels.