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Poliomyelitis, caused by the poliovirus, primarily affects the central nervous system, leading to muscle weakness and paralysis, particularly in the lower limbs. While it can cause non-specific symptoms like fever and headache, it does not typically cause parotid gland swelling (parotitis) or testicular swelling (orchitis), making this diagnosis inconsistent with the client's constellation of specific findings.

Infectious mononucleosis, caused by the Epstein-Barr virus (EBV), is commonly known as the "kissing disease" and typically presents with a classic triad of fever, pharyngitis (sore throat), and lymphadenopathy (swollen lymph nodes). Although it can cause generalized malaise, it does not characteristically cause parotid swelling or orchitis, which are key features in this client's presentation.

Herpes zoster, or shingles, is caused by the reactivation of the varicella-zoster virus (VZV) and manifests as a painful, blistering rash typically confined to a dermatome, or specific sensory nerve distribution. It rarely presents only with fever, headache, malaise, parotitis, and orchitis without a dermatomal rash, making this an unlikely diagnosis for these symptoms.

While systemic lupus erythematosus (SLE) is a chronic autoimmune, rheumatic disease, and joint involvement (arthralgia or non-erosive arthritis) is very common, it is fundamentally a systemic disorder. It can affect virtually any organ system, including the kidneys, heart, lungs, blood, and nervous system, so stating it mostly affects the joints underestimates its widespread potential for serious organ damage.

Systemic lupus erythematosus (SLE) is a chronic, incurable autoimmune disease where the body's immune system attacks its own tissues, leading to inflammation and tissue damage. Medications, such as corticosteroids and immunosuppressants, can effectively manage symptoms and control disease activity, especially with early diagnosis, but they do not offer a cure for the underlying autoimmune disorder.

While dermatological manifestations, such as the classic "butterfly" malar rash, are a hallmark of SLE, the disease is by nature systemic and poly-organic. It frequently causes life-threatening complications in major organs like the kidneys (lupus nephritis), central nervous system, and cardiovascular system, so this statement is grossly inaccurate and minimizes the disease's potential severity.

Both parents working outside the home is common in many families and is not considered an independent risk factor for child abuse. Economic stability, often associated with parental employment, may actually decrease stress compared to families experiencing financial hardship, making this a neutral or protective factor rather than a risk factor.

A child's father being the primary caretaker does not inherently increase the risk of abuse. The risk factors for child abuse are related to specific parental characteristics (e.g., substance abuse, history of abuse, mental illness) or situational stressors, not the gender identity of the parent who assumes the primary caregiving role.

Living in an apartment or in high-density housing is a socioeconomic factor often correlated with, but not a direct cause of, child abuse. While poverty and housing stress are known risk factors, the type of dwelling itself is less significant than specific stressors like unemployment, social isolation, and parental psychological instability.

The immediate assessment of a trauma client follows a systematic approach known as the primary survey, prioritizing life-threatening injuries based on the ABCs (Airway, Breathing, Circulation). While the skeletal system is assessed in the secondary survey, initial focus must be on the respiratory and cardiovascular systems to ensure adequate oxygenation and perfusion, followed by a rapid neurologic assessment (Disability).

Gastrointestinal assessment is part of the secondary survey, focusing on potential abdominal injuries, and is not one of the immediate life-saving priorities. The neurologic system, crucial for determining brain function and spinal cord injury, must be assessed immediately after circulation, while the respiratory and cardiovascular systems must be addressed first to prevent irreversible damage.

The endocrine system, which regulates hormones and metabolism, is assessed later during the secondary survey or ongoing monitoring. It is not an immediate life-saving priority following acute trauma. The primary focus must remain on the ABCs (Airway, Breathing, Circulation) and Disability (Neurologic assessment) to identify and treat injuries that pose the most immediate threat to the child's survival.

A heart rate of 140 beats per minute is within the normal physiological range for an infant, which is generally 100 to 160 beats per minute. This rate is considered acceptable and does not warrant holding the prescribed dose of digoxin, assuming other parameters and clinical signs of toxicity are absent. Digoxin aims to improve cardiac contractility and may slightly slow the rate but 140 is a safe rate.

An apical pulse rate of 100 beats per minute sits at the lower boundary of the normal range for an infant, which spans from 100 to 160 beats per minute. While close to the cutoff, it is still technically acceptable for administering digoxin. The nurse would monitor closely, but the dose would generally not be withheld unless the rate was less than 90 or 100, depending on the facility policy.

A heart rate of 120 beats per minute is well within the expected and safe normal range for an infant, which typically extends from 100 to 160 beats per minute. This rate is adequate and does not suggest bradycardia or pose any immediate concern regarding digoxin administration. The dose should be given as scheduled, and continued monitoring should take place.

While positioning the child upright can help improve lung expansion and ease breathing, it is not the most immediate priority when a child has significant signs of respiratory distress, including labored breathing and a low oxygen saturation of 90. The immediate need is to increase the partial pressure of oxygen in the blood to prevent hypoxemia and potential organ damage.

Sedation should be avoided in a child with respiratory distress unless agitation is significantly interfering with ventilatory efforts or necessary procedures. Sedatives can further depress respiratory drive, potentially worsening hypoventilation and the existing hypoxemia, which would be detrimental to the child's recovery in this critical scenario.

Checking capillary refill time is an assessment of peripheral perfusion, which is important but secondary to immediate oxygenation and ventilation support. While circulatory status is critical, addressing the life-threatening hypoxemia, as indicated by the 90 oxygen saturation, takes precedence in the initial management of a respiratory emergency.

Bradypnea, which is an abnormally slow respiratory rate, is not a typical initial or hallmark sign of developing heart failure in a child. Instead, tachypnea (an increased respiratory rate) is commonly observed as the body attempts to compensate for pulmonary congestion or decreased cardiac output, making bradypnea an unlikely finding.

Inability to sweat, known as anhidrosis, is usually associated with conditions affecting the nervous system or sweat glands, such as certain genetic disorders or severe dehydration. This symptom is not a characteristic clinical manifestation of heart failure, which primarily involves impaired cardiac function and circulatory congestion leading to respiratory and edema symptoms.

Splenomegaly, or enlargement of the spleen, is a nonspecific finding often seen in chronic venous congestion from heart failure, but also in many other conditions, including infections and hematological disorders. It is not one of the most common or earliest signs of heart failure in a child, which often presents first with signs like tachypnea, poor feeding, or periorbital edema.

Providing false reassurance, such as stating "he will be okay," is not therapeutic because the outcome is uncertain, especially during active resuscitation efforts. The nurse must maintain honesty and support while acknowledging the gravity of the situation. Offering simple presence and resource information is much more supportive and appropriate for the family.

This response inappropriately questions the parents' actions and implies blame or judgment during an emotionally devastating crisis. Such a statement is highly unsupportive, unprofessional, and potentially damaging to the therapeutic relationship. The focus must remain on providing comfort, support, and necessary information to the grieving family.

Although it attempts to validate their feelings of fear, this response focuses on a specific, potentially guilt-inducing detail (the driving) which is likely irrelevant to the immediate need for support. It may exacerbate parental guilt during a critical time. A supportive response should be broad and non-judgmental, addressing their general distress and needs.

Varicella, or chickenpox, is caused by a virus, and therefore antibiotics are completely ineffective for treatment or reducing contagiousness. The child must be isolated until all lesions have scabbed over, which indicates the end of the contagious period. Returning to school based on starting an antibiotic regimen shows a misunderstanding of the required isolation period.

While good hand hygiene is generally important for preventing the spread of many diseases, the primary mode of transmission for varicella is airborne or direct contact with vesicular fluid. The main method of contagion control is strict isolation until all lesions are fully crusted over, not just frequent hand washing, making this statement incomplete for effective prevention.

The varicella vaccine is highly effective, but it does not offer 100 percent protection. Breakthrough infection can occur, though it is often a milder case. Therefore, the statement that the sister "can't catch it" is scientifically inaccurate and creates a false sense of security, showing the parents need further education on vaccine efficacy and breakthrough risk.

A preference for certain toys is a common, non-pathological finding in toddlers as they develop individual interests and preferences. While extreme rigidity in play or an inability to shift focus may be concerning, simple preference alone does not typically indicate a significant developmental delay in a 30-month-old child, but rather a normal expression of autonomy. Further assessment would involve observing the quality and functional use of play.

Food selectivity or "picky eating" is a very frequent and normal developmental phase during toddlerhood, often peaking around age two to five years, and is not usually indicative of a neurological or pervasive developmental disorder. A child's refusal to frequently try new foods, especially in the absence of weight loss or growth failure, is not an immediate alarm for developmental delay.

Restlessness in a structured public setting like a restaurant with a waiting period is an expected behavior for a 30-month-old toddler due to their limited attention span and developmental need for gross motor activity and immediate gratification. This is a common age-appropriate reaction to boredom and constraint, not a sign of major developmental pathology.