A nurse is reviewing the laboratory findings of a client who has type 1 diabetes mellitus. Which of the following findings should the nurse report to the provider immediately?

A. 120 mL (4 oz) sugar-free soda: Sugar-free soda does not contain carbohydrates or glucose, which are necessary to treat hypoglycemia. It is sweetened with artificial sweeteners that do not raise blood glucose levels. Offering this would not correct a hypoglycemic episode and could result in worsening symptoms.
B. Three saltine crackers:Three saltine crackers contain only about 6–7 grams of carbohydrates, which is not enough to effectively manage mild hypoglycemia. A total of 15 grams of fast-acting carbohydrates is needed to raise blood glucose to a safe level. While crackers are useful for long-term blood sugar stabilization, they are not sufficient for initial correction.
C. 120 mL (4 oz) fruit juice: Fruit juice is a fast-acting carbohydrate and is quickly absorbed into the bloodstream, making it effective for treating mild hypoglycemia. Four ounces of juice typically contain approximately 15 grams of carbohydrates, meeting the recommended amount for correcting low blood glucose promptly.
D. Three pieces of hard candy: While hard candy can be used to treat hypoglycemia, three small pieces usually provide only about 9–12 grams of carbohydrates, depending on the brand and size. This may be inadequate to raise blood glucose effectively. The client would likely need 4–5 pieces to meet the 15-gram threshold.

A. "I should report any tingling I feel around my mouth. Tingling around the mouth, known as perioral paresthesia, is a classic symptom of hypocalcemia and can indicate worsening calcium deficiency or the onset of tetany. This symptom must be reported immediately because it suggests neuromuscular irritability that can progress to serious complications like laryngospasm or seizures if left untreated.
B. "I should take a 2,500-milligram calcium supplement every day." A daily calcium supplement of 2,500 mg exceeds the recommended upper limit for most adults, which is about 2,000 mg per day from supplements. Excessive calcium intake can lead to hypercalcemia, kidney stones, and other complications. Supplement dosage should be based on individual needs and prescribed by a healthcare provider.
C. "I should avoid dairy products, including cheese: Dairy products such as cheese, milk, and yogurt are rich sources of dietary calcium. Avoiding them would reduce calcium intake, which is counterproductive for a client with hypocalcemia. Unless contraindicated due to lactose intolerance or allergies, these foods are encouraged to help manage low calcium levels.
D. "I should expect my blood pressure to be very low." Hypocalcemia does not typically result in very low blood pressure. In fact, it more commonly causes neuromuscular symptoms such as muscle cramps, tetany, and tingling sensations. Low calcium levels may have some cardiovascular effects, but persistent hypotension is not a hallmark feature of hypocalcemia.