A nurse is reinforcing teaching about foot care to a client who has diabetes mellitus. Which of the following information should the nurse include in the teaching?

A. Hyperbilirubinemia: Hyperbilirubinemia in neonates is commonly due to immature liver function and the breakdown of red blood cells after birth. It is not linked to maternal folic acid deficiency and would not be prevented through maternal folic acid supplementation.

B. Hyperemesis gravidarum: Hyperemesis gravidarum is a severe form of nausea and vomiting that occurs during pregnancy, affecting the mother rather than the neonate. Folic acid supplementation does not prevent this condition, as it is more related to hormonal changes during pregnancy.

C. Iron deficiency anemia: Iron deficiency anemia occurs when there is an inadequate amount of iron, not folic acid, in the mother’s or infant’s diet. While iron is important during pregnancy for both the mother and the developing fetus, folic acid deficiency primarily affects neural tube development, not iron levels or red blood cell production in the same way. Iron supplementation is recommended during pregnancy to prevent iron deficiency anemia.

D. Neural tube defects: Neural tube defects, such as spina bifida and anencephaly, are directly linked to folic acid deficiency during early pregnancy. Adequate folic acid intake before conception and during early pregnancy significantly reduces the risk of these serious birth defects affecting the brain and spine.

• alcohol intoxication: Although the client consumed one beer, this small amount is unlikely to cause unresponsiveness, respiratory depression, or the need for naloxone administration. Alcohol intoxication alone does not explain the profound sedation and pinpoint pupils observed.
• alcohol withdrawal: Alcohol withdrawal typically presents with signs like agitation, tremors, hallucinations, and seizures, not sedation, miosis, and depressed respiratory drive. The client’s symptoms are inconsistent with alcohol withdrawal.
• hallucinogen intoxication: Hallucinogen use usually leads to agitation, paranoia, hallucinations, and dilated pupils (mydriasis), not the sedated state, respiratory depression, and miotic pupils that this client is exhibiting.
• opioid intoxication: The client's unresponsiveness, respiratory depression, and pinpoint pupils, combined with a positive response to naloxone, are classic indicators of opioid intoxication. These findings directly align with the expected effects of opioid overdose.
• opioid withdrawal: Opioid withdrawal presents with signs like agitation, mydriasis, diarrhea, piloerection, and flu-like symptoms. The client’s current state of sedation and miotic pupils contradicts what would be seen during opioid withdrawal.
• amount of alcohol consumed: The small amount of alcohol (one beer) does not correlate with the severity of the client’s clinical presentation. Thus, alcohol consumption is not the primary factor contributing to the current state.
• breath sounds: Breath sounds are clear and equal bilaterally, indicating that the lungs are not the source of the client's critical condition. There is no evidence of respiratory infection or pulmonary complications.
• abdominal findings: Decreased bowel sounds are common in opioid intoxication due to decreased gastrointestinal motility. However, while supportive, this finding is less definitive than the hallmark sign of pupil constriction.
• pupil characteristics: The presence of pinpoint pupils (miosis) is a hallmark sign of opioid intoxication. Miotic pupils, especially in an unresponsive client who improved after naloxone, strongly support opioid overdose as the primary diagnosis.
• current temperature: The client's temperature is within normal limits, providing no significant diagnostic clue toward explaining the cause of unresponsiveness or respiratory depression.