A 12-year-old recently began bedwetting after parental divorce.
The physical exam is unremarkable. What should the nurse do next?

Choice A rationale

Persistent fever, elevated white blood cell count (normal range: 4,000-11,000 cells/µL), and increased pain after 72 hours of antibiotic treatment for osteomyelitis indicate a lack of therapeutic response. This suggests the current antibiotic regimen may be ineffective, or the infection is not responding as expected. Prompt notification of the provider is crucial for re-evaluation of the treatment plan, potential antibiotic adjustment, or further diagnostic investigation to prevent complications like sepsis or chronic osteomyelitis.

Choice B rationale

While pain management is important, requesting only oral analgesics addresses a symptom without addressing the underlying lack of improvement in the infection. Untreated or inadequately treated osteomyelitis can lead to significant morbidity. Prioritizing symptomatic relief over addressing the root cause can delay appropriate medical intervention and worsen the patient's condition.

Choice C rationale

While calcium (normal range: 8.5-10.5 mg/dL) is vital for bone health, encouraging calcium-rich foods is a long-term supportive measure for bone healing. It does not address the immediate and concerning signs of ongoing, uncontrolled infection. Addressing the active infection takes precedence over nutritional support for healing at this stage.

Choice D rationale

While antibiotic therapy does take time to show full effect, 72 hours with worsening symptoms, including elevated WBC, suggests the current therapy is failing. Reassuring the family without addressing these objective signs of non-improvement can delay necessary medical intervention and potentially harm the patient by allowing the infection to progress further.

Choice A rationale

Acupressure involves applying pressure to specific points on the body, aiming to stimulate energy flow and relieve pain. While it can promote relaxation and analgesia by releasing endorphins, its direct effect on significantly reducing blood pressure and respiratory rate in acute anxiety may be less pronounced compared to methods emphasizing controlled breathing techniques.

Choice B rationale

Effleurage is a light, stroking massage, typically applied to the abdomen during contractions. This technique can distract from pain and promote relaxation by stimulating large nerve fibers, thereby reducing pain perception. However, its primary physiological impact is generally on pain modulation and comfort, rather than a direct, strong reduction in elevated blood pressure and respiratory rate.

Choice C rationale

The Bradley method, also known as "husband-coached childbirth," emphasizes natural childbirth, focusing on deep abdominal breathing, relaxation, and partner support. While it promotes a calm environment and can reduce overall stress, its specific techniques for immediate physiological regulation of acutely elevated blood pressure and erratic respirations may not be as direct as methods specifically teaching controlled breathing.

Choice D rationale

The Lamaze method focuses on controlled breathing and relaxation techniques during labor. These techniques, particularly patterned breathing, directly influence the autonomic nervous system by increasing vagal tone, which can lead to a decrease in heart rate and respiratory rate, thereby lowering blood pressure and promoting a sense of calm during periods of anxiety.

Choice E rationale

Yoga incorporates physical postures, breathing exercises (pranayama), and meditation. While highly effective for long-term stress reduction and improving cardiovascular health, its immediate application in a laboring client experiencing acute anxiety with elevated vital signs might be less practical for immediate physiological regulation compared to targeted breathing methods like Lamaze.