A nurse is caring for a child who was admitted with suspected rheumatic fever. The provider prescribes an antistreptolysin O (ASO) titer. The parent asks the nurse about the purpose of the test. Which of the following responses should the nurse make?

Choice A: This instruction is incorrect, as withholding insulin dose if feeling nauseous can cause hyperglycemia, which is high blood sugar, and diabetic ketoacidosis, which is a life-threatening condition that occurs when the body breaks down fat for energy and produces ketones. Ketones are acidic substances that can cause nausea, vomiting, abdominal pain, dehydration, or coma. The child should take their insulin dose as prescribed and monitor their blood sugar levels more frequently when they are sick.

Choice B: This instruction is unnecessary, as notifying the provider if blood glucose levels are within normal parameters does not require any action or intervention. The child and the parents should notify the provider if blood glucose levels are above or below the target range, which is usually 70 to 180 mg/dL for children with type 1 diabetes mellitus. The child and the parents should also notify the provider if they have any signs or symptoms of hypoglycemia, hyperglycemia, or diabetic ketoacidosis.

Choice C: This instruction is incorrect, as limiting fluid intake during mealtime can cause dehydration, which can worsen the symptoms and complications of type 1 diabetes mellitus. Dehydration can cause increased thirst, dry mouth, fatigue, headache, or dizziness. The child should drink plenty of fluids during meal time and throughout the day to hydrate their body and flush out excess glucose and ketones.

Choice D: This instruction is correct, as testing the urine for ketones can help detect diabetic ketoacidosis, which is a life-threatening condition that occurs when the body breaks down fat for energy and produces ketones. Ketones are acidic substances that can cause nausea, vomiting, abdominal pain, dehydration, or coma. The child should test their urine for ketones when their blood sugar levels are above 240 mg/dL or when they are sick. The child and the parents should notify the provider if the urine test shows moderate or large amounts of ketones.

Choice A: Toys that can't be dry cleaned or washed do not need to be thrown out, as they can be treated by sealing them in plastic bags for two weeks or placing them in a freezer for two days. This will kill any lice or nits that may have been transferred from the child's head.

Choice B: Nits will not always be present, as they can be removed by using a fine-toothed comb or applying products that loosen their attachment to the hair shafts. Nits are the eggs of lice that are glued to the hair near the scalp. Nits can hatch into nymphs within seven to ten days and mature into adult lice within another seven to ten days.

Choice C: All recently used clothing, bedding, and towels must be washed in hot water, as this will kill any lice or nits that may have been transferred from the child's head. Hot water means at least 54°C/130°F for at least ten minutes. The items should also be dried in high heat for at least twenty minutes.

Choice D: Treating all the family members is not necessary, as only those who have evidence of lice or nits should be treated with medicated shampoos or lotions that kill lice and prevent re-infestation. Treating all the family members may cause unnecessary exposure to chemicals or resistance to treatment.