A nurse is caring for a child who has influenza. The nurse should identify which of the following statements by the parent indicates the child has an increased risk for Reye syndrome.

Choice A reason: This choice is correct because examining the child's tympanic membrane at the end of the physical examination is the best strategy to avoid upsetting or frightening the child. The tympanic membrane is the thin membrane that separates the outer ear from the middle ear, and it can be examined by using an otoscope, which is a device that has a light and a magnifying lens. Examining the tympanic membrane may be uncomfortable or painful for the child, especially if they have an ear infection or inflammation. Therefore, performing this procedure at the end of the examination can help to minimize the child's distress and resistance.

Choice B reason: This choice is incorrect because examining the child's tympanic membrane before auscultating the chest and abdomen is not a good strategy to avoid upsetting or frightening the child. Auscultating the chest and abdomen is a procedure that involves listening to the sounds of the heart, lungs, and bowel by using a stethoscope, which is a device that has a chest piece and earpieces. Auscultating the chest and abdomen may be soothing or relaxing for the child, as it does not cause any discomfort or pain. Therefore, performing this procedure before examining the tympanic membrane can help to calm and distract the child.

Choice C reason: This choice is incorrect because examining the child's tympanic membrane at the beginning of the physical examination is not a good strategy to avoid upsetting or frightening the child. Examining the tympanic membrane at the beginning of the examination may cause anxiety or fear in the child, which can affect their cooperation and trust for the rest of the examination. Therefore, performing this procedure at the beginning of the examination can increase the child's distress and resistance.

Choice D reason: This choice is incorrect because examining the child's tympanic membrane before examining the
head and neck is not a good strategy to avoid upsetting or frightening the child. Examining the head and neck is a procedure that involves inspecting and palpating the scalp, hair, face, eyes, ears, nose, mouth, throat, lymph nodes, and thyroid gland. Examining the head and neck may be easy or pleasant for the child, as it does not cause any discomfort or pain. Therefore, performing this procedure before examining the tympanic membrane can help to establish rapport and confidence with the child.

Choice A reason: This choice is incorrect because taking glyburide with breakfast is not recommended for an adolescent who has type 1 diabetes mellitus. Glyburide is an oral hypoglycemic medication that lowers blood glucose levels by stimulating insulin secretion from the pancreas. It may be used for clients who have type 2 diabetes mellitus, but it does not work for clients who have type 1 diabetes mellitus or DKA.

Choice B reason: This choice is correct because obtaining an influenza vaccine annually is recommended for an adolescent who has type 1 diabetes mellitus. The influenza vaccine is a vaccine that protects against influenza, a viral infection that affects the respiratory system. It may prevent or reduce the severity of influenza and its complications, such as pneumonia or sepsis. It is recommended for everyone who is 6 months or older, especially those who have chronic conditions such as diabetes mellitus that increase their risk of influenza-related complications.

Choice C reason: This choice is incorrect because administering glucagon for hyperglycemia is not indicated for an adolescent who has type 1 diabetes mellitus. Glucagon is a hormone that raises blood glucose levels by stimulating glycogen breakdown in the liver. It may be used for clients who have hypoglycemia, which is a condition in which blood glucose levels are lower than normal (less than 70 mg/dL). It may cause symptoms such as sweating, trembling, confusion, or loss of consciousness. However, in type 1 diabetes mellitus, hyperglycemia (high blood glucose levels) rather than hypoglycemia is more likely to occur due to insulin deficiency or resistance.

Choice D reason: This choice is incorrect because injecting insulin in the deltoid muscle is not an optimal method for an adolescent who has type 1 diabetes mellitus. Insulin is a hormone that lowers blood glucose levels by facilitating glucose uptake into the cells. It may be administered by injection or infusion, and it may vary in onset, peak, and duration of action. The preferred sites for insulin injection are the abdomen, the thighs, the buttocks, or the upper arms, as they have more subcutaneous fat and less muscle tissue. Injecting insulin into the deltoid muscle may cause faster absorption and shorter duration of action, which can affect blood glucose control and increase the risk of hypoglycemia.