A home health nurse is reinforcing teaching with a client about kitchen safety. Which of the following instructions should the nurse include about fire extinguisher use?

A. Initiate NPO status: The child is already unable to tolerate oral intake due to vomiting, but routine NPO status is not always necessary unless prescribed. With mild to moderate dehydration, oral rehydration may be attempted if tolerated, and withholding all fluids could worsen fluid deficit.

B. Maintain IV fluids: The child demonstrates signs of moderate dehydration, including weight loss, sunken eyes, delayed skin turgor, and reduced urine output. IV fluid therapy is necessary to restore intravascular volume, correct electrolyte imbalances, and prevent progression to hypovolemic shock.

C. Maintain strict intake and output: Accurate monitoring of fluid intake and urine/stool output is critical to assess hydration status and guide IV fluid replacement. The child’s ongoing diarrhea and low urine output indicate the need for close tracking to prevent further fluid deficit.

D. Weigh the child daily: Daily weight measurement is an objective and sensitive indicator of hydration status in pediatric clients. The child’s 0.5 kg (1 lb) weight loss over 24 hours reflects significant fluid loss and helps guide ongoing fluid management.

E. Instruct the guardian about proper hand hygiene: The child has a confirmed Escherichia coli infection, which is highly transmissible via the fecal–oral route. Educating the guardian about proper handwashing helps prevent spread to others and reinforces infection control practices.

F. Check the child's temperature rectally: Rectal temperature measurement is invasive and may increase discomfort or risk of injury, especially in a drowsy or irritable toddler. Oral or axillary methods are safer and sufficient for routine monitoring.

G. Monitor laboratory values: Electrolytes, BUN, creatinine, and other relevant labs are crucial to assess the severity of dehydration, renal perfusion, and metabolic disturbances. Trends in these values guide fluid and electrolyte replacement and indicate improvement or deterioration.

A. Administer bupropion 1 hr before meals: Bupropion is contraindicated in clients with bulimia nervosa due to an increased risk of seizures. Antidepressants such as SSRIs, like fluoxetine, are preferred for managing bulimia and comorbid depression.

B. Allow the client access to food throughout the day: Unrestricted access to food can trigger binge-eating episodes in clients with bulimia nervosa. Structured meal planning with scheduled eating times is more effective in reducing binge-purge behaviors.

C. Weigh the client once weekly: Weekly weighing is insufficient for monitoring rapid weight fluctuations associated with bulimia. Daily or more frequent monitoring, combined with close observation, is recommended to identify sudden changes and ensure safety.

D. Observe the client for 1 hr after meals: Post-meal observation helps prevent purging behaviors, such as self-induced vomiting or misuse of laxatives. This intervention directly addresses the core pathology of bulimia nervosa and supports safety and behavioral modification strategies.