A nurse is caring for a client who is newly diagnosed with type 1 diabetes mellitus. The nurse should recognize that the client needs a referral for diabetic education when the client does which of the following?

A. Splenomegaly is not typically associated with hepatitis A. Hepatitis A primarily affects the liver and does not usually result in enlargement of the spleen.
B. Abdominal pain is a common symptom of hepatitis A. It can range from mild discomfort to severe pain in the right upper quadrant of the abdomen, where the liver is located.
C. Hepatitis A does not typically cause irregular heart rate. The cardiovascular system is generally unaffected by hepatitis A infection.

D. Tarry stools, also known as melena, typically result from upper gastrointestinal bleeding and are not a characteristic symptom of hepatitis A.

A. Encourage the client to gain 2.3 kg (5 lb) per week. This is not appropriate. Weight gain should be gradual in clients with anorexia nervosa, typically around 0.5 to 1 kg (1 to 2 pounds) per week, to prevent refeeding syndrome and support psychological adjustment.

B. Monitor the client for 15 min after meals. This is the correct intervention. Clients with anorexia nervosa may engage in purging behaviors (such as vomiting or excessive exercise) after meals. Monitoring for a period of time after eating helps prevent these behaviors and ensures safety.

C. Weigh the client each morning after voiding. Weighing clients with anorexia nervosa can be distressing and should be done consistently at the same time each day (ideally, before breakfast) but does not need to be after voiding. This may not be the priority intervention compared to monitoring post-meal behavior.

D. Reinforce teaching about healthy eating during meals. While teaching about healthy eating is important, it should not be done during meals, as clients with anorexia nervosa may have difficulty focusing on this information when under stress during eating. Instead, nutrition education should be provided outside of meals.