A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new diagnosis of diabetes mellitus. Which of the following statements by the parent indicates a need for further teaching?

Choice A: Allowing for imaginative play with peers without supervision is not an appropriate intervention for a child who has autism spectrum disorder, as it can cause frustration, anxiety, or isolation for the child. A child who has autism spectrum disorder may have difficulty with social skills, communication, and imagination, which can affect their ability to interact and play with others. The nurse should provide structured and supervised play activities that promote socialization and cooperation.

Choice B: Providing a completely unpredictable schedule that adjusts to the child's interests is not an appropriate intervention for a child who has autism spectrum disorder, as it can cause confusion, stress, or tantrums for the child. A child who has autism spectrum disorder may have difficulty with transitions, changes, and flexibility, which can affect their ability to cope and adapt to different situations. The nurse should provide a consistent and predictable schedule that follows a routine and gives clear expectations.

Choice C: Allowing for adjustment of rules to correlate with the child's behavior is not an appropriate intervention for a child who has autism spectrum disorder, as it can cause inconsistency, insecurity, or manipulation for the child. A child who has autism spectrum disorder may have difficulty understanding and following rules, which can affect their ability to behave and function appropriately. The nurse should provide firm and fair rules that are enforced consistently and respectfully.

Choice D: Establishing a reward system for positive behavior with prizes is an appropriate intervention for a child who has autism spectrum disorder, as it can provide motivation, reinforcement, and feedback for the child. A child who has autism spectrum disorder may have difficulty with learning and performing new skills, which can affect their ability to achieve and succeed. The nurse should provide a reward system that recognizes and rewards positive behavior with tangible or intangible prizes.

Choice A reason: This choice is incorrect because having them share a room with a child with active mumps may expose them to infection and worsen their condition. A child who is immunosuppressed due to leukemia or chemotherapeutic agents has a weakened immune system and is more susceptible to infections from bacteria, viruses, fungi, or parasites. Therefore, they should be placed in a private room or cohorted with another immunosuppressed child.

Choice B reason: This choice is incorrect because restricting oral fluids may cause dehydration and electrolyte imbalance in the child who is immunosuppressed due to leukemia or chemotherapeutic agents. A child who is immunosuppressed due to leukemia or chemotherapeutic agents may have increased fluid losses from vomiting, diarrhea, fever, or sweating. Therefore, they should be encouraged to drink adequate fluids to maintain hydration and electrolyte balance.

Choice C reason: This choice is incorrect because strict isolation may cause psychological distress and social isolation in the child who is immunosuppressed due to leukemia or chemotherapeutic agents. A child who is immunosuppressed due to leukemia or chemotherapeutic agents may benefit from protective isolation, which involves using standard precautions and additional measures such as wearing gloves, gowns, masks, or eye protection when in contact with the child or their body fluids. However, strict isolation, which involves limiting visitors and activities, may harm the child's emotional and developmental well-being.

Choice D reason: This choice is correct because using good handwashing is essential nursing care for a child who is immunosuppressed due to leukemia or chemotherapeutic agents. Handwashing is the most effective way to prevent the transmission of microorganisms that can cause infections. The nurse should wash their hands before and after touching the child or their belongings, and teach the child and their family members to do the same. The nurse should also use alcohol-based hand rubs when water and soap are not available.