A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parent indicates a need for further teaching?

Choice A: A 13% weight loss is a sign of severe dehydration in an infant, as it indicates a significant loss of body fluids and electrolytes. Dehydration can occur in an infant who has acute gastroenteritis, which is a condition that causes inflammation of the stomach and intestines, leading to vomiting and diarrhea. A 13% weight loss can also cause other signs of dehydration, such as sunken eyes, dry mouth, decreased urine output, and lethargy.

Choice B: A bulging anterior fontanel is not a sign of dehydration in an infant, but rather a sign of increased intracranial pressure, which can be caused by various conditions, such as meningitis, encephalitis, or head trauma. A bulging anterior fontanel can also cause other signs of increased intracranial pressure, such as irritability, headache, vomiting, or seizures.

Choice C: A capillary refill of 3 seconds is not a sign of dehydration in an infant, but rather a sign of normal perfusion and circulation. Capillary refill is the time it takes for the color to return to the nail bed after applying pressure. A normal capillary refill is less than 2 seconds. A prolonged capillary refill of more than 2 seconds can indicate poor perfusion and circulation, which can be caused by various conditions, such as shock, hypothermia, or heart failure.

Choice D: Bradypnea is not a sign of dehydration in an infant, but rather a sign of decreased respiratory rate, which can be caused by various conditions, such as hypoxia, narcotic overdose, or brain injury. Bradypnea can also cause other signs of respiratory distress, such as cyanosis, confusion, or loss of consciousness.

Choice A: A 10-year-old child who has sickle cell anemia and reports severe chest pain should be assessed first, as this is a sign of acute chest syndrome, which is a life-threatening complication of sickle cell disease. Acute chest syndrome occurs when sickle-shaped red blood cells block the blood flow to the lungs, causing hypoxia, inflammation, and infection. Acute chest syndrome can lead to respiratory failure, pulmonary hypertension, or stroke.

Choice B: A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016 should be assessed second, as this is a sign of dehydration, which is a common complication of diabetes insipidus. Diabetes insipidus is a condition in which the body does not produce enough antidiuretic hormone (ADH) or does not respond to it properly, resulting in excessive urination and thirst. Dehydration can cause electrolyte imbalance, hypotension, or shock.

Choice C: A 4-year-old child who has asthma and an O2 sat of 97% should be assessed third, as this is a sign of adequate oxygenation, which is a desired outcome of asthma management. Asthma is a condition in which the airways become inflamed, narrow, and produce excess mucus, causing difficulty breathing, wheezing, coughing, or chest tightness. Asthma can be triggered by allergens, irritants, exercise, or infections.

Choice D: A 1-year-old toddler who has roseola and a temperature of 39°C/102.2°F should be assessed last, as this is a sign of a mild viral infection, which is self-limiting and usually resolves within a week. Roseola is a common childhood illness that causes a high fever followed by a pink rash on the trunk, face, and limbs. Roseola can also cause irritability, swollen lymph nodes, or mild diarrhea.