A patient with congestive heart failure is prescribed a low-sodium diet. Which of the following foods, if chosen by the patient, indicates further teaching is necessary? (Select 3 options that apply)

Rationale:
A. Diabetes insipidus can lead to profound dehydration due to excessive fluid loss. A urine specific gravity of 1.002 indicates very dilute urine, supporting the concern. This child is at immediate risk for hypovolemic shock, so the nurse should assess them first.
B. A pulse oximetry of 95% is within acceptable range for a child with asthma, suggesting no acute distress at this time.
C. Roseola with a fever of 39°C is expected; while monitoring is needed, it's not the highest priority.
D. Pain of 6/10 in sickle cell anemia is concerning and requires attention, but it is not as emergent as potential fluid imbalance in diabetes insipidus.

Rationale:

A. Request a potassium replacement: The client's potassium level is 3.0 mEq/L, which indicates hypokalemia (normal range: 3.5–5.0 mEq/L). TPN can cause electrolyte shifts, so potassium supplementation is appropriate and should be initiated to prevent complications like arrhythmias and muscle weakness.

B. Administer glucagon IM: This is used to treat severe hypoglycemia. The client’s glucose is 72 mg/dL, which is within the normal range (70–100 mg/dL fasting), so glucagon is not needed.

C. Check the client for a positive Chvostek's sign: Chvostek’s sign is associated with hypocalcemia, not hypokalemia, and calcium levels were not mentioned as abnormal here.

D. Discontinue the TPN infusion: Discontinuing TPN is not appropriate without a critical reason. Electrolyte imbalances are common during TPN therapy and are typically managed by adjusting the TPN formulation rather than stopping it altogether.