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: This statement does not indicate a need for further teaching, as it is correct that insulin can be injected anywhere there is adipose tissue. Adipose tissue is the layer of fat under the skin that can absorb insulin and prevent damage to muscles or organs. The common sites for insulin injection are the abdomen, thighs, buttocks, or upper arms.

Choice B: This statement does not indicate a need for further teaching, as it is correct that the child should rotate sites after 5 injections in one area. Rotating sites can prevent lipodystrophy, which is a condition that causes abnormal changes in fat tissue due to repeated injections. Lipodystrophy can affect the appearance and absorption of insulin in the affected area.

Choice C: This statement indicates a need for further teaching, as it is incorrect that the child should aspirate before injecting the insulin. Aspiration is the process of pulling back on the plunger of the syringe to check for blood before injecting the medication. Aspiration is not recommended for insulin injection, as it can cause pain, bruising, or leakage of insulin from the injection site.

Choice D: This statement does not indicate a need for further teaching, as it is correct that insulin should be injected at a 90-degree angle. Injecting insulin at a 90-degree angle can ensure that the medication reaches the adipose tissue and prevents skin irritation or muscle damage. The only exception is if the child has very thin skin or uses very short needles, in which case they may inject at a 45-degree angle.

Choice A: Performing range of motion on the infant's hips is not appropriate for an infant who has myelomeningocele, which is a type of spina bifida that causes a sac-like protrusion of the spinal cord and nerves through an opening in the spine. Performing range of motion on the infant's hips can cause nerve damage or pain in the lower extremities, which may already be affected by the condition.

Choice B: Taking an axillary temperature is appropriate for an infant who has myelomeningocele, as it is a non-invasive and accurate method of measuring body temperature. An axillary temperature is taken by placing a thermometer under the armpit and holding the arm close to the body. Taking an axillary temperature can help monitor for signs of infection or inflammation, which are common complications of myelomeningocele.

Choice C: Placing the infant in a side-lying position is not appropriate for an infant who has myelomeningocele, as it can cause pressure or friction on the sac and increase the risk of rupture or infection. The correct position for an infant with myelomeningocele is prone with hips slightly flexed and legs abducted. This position can prevent trauma and promote drainage from the sac.

Choice D: Maintaining a dry dressing over the sac is not appropriate for an infant who has myelomeningocele, as it can cause irritation or infection of the sac and surrounding skin. The correct dressing for an infant with myelomeningocele is moist and sterile with saline or antibiotic solution. This dressing can prevent drying and cracking of the sac and reduce bacterial growth.