A nurse is assessing a child who was recently adopted from a foreign country and has not yet received any immunizations. The child has a high fever, rhinitis, and sore throat: The nurse also notes small, irregular, bright red spots with a blue-white center on the buccal membrane. What would the nurse suspect?

A. “Bring the child to the emergency room immediately.”

This is the most appropriate recommendation given the symptoms described, including the barking cough, elevated temperature, and blueness around the mouth. These signs may indicate respiratory distress, and immediate medical attention is needed.

B. “Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief.”

Taking a child out into the cold is not a recommended intervention for respiratory distress. This action may exacerbate the child's breathing difficulties. The symptoms described require urgent evaluation in a healthcare setting.

C. “Take the child into the steam-filled room for an additional 15 minutes. If there is no relief, bring the child to the emergency room.”

While steam may provide temporary relief for mild respiratory symptoms, the presence of blueness around the mouth suggests a more severe condition. Delaying care by waiting for an additional 15 minutes may not be appropriate in this situation.

D. “Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there’s no relief in an hour.”

Using a cool mist humidifier may be helpful for mild respiratory symptoms, but the severity of the symptoms described, especially blueness around the mouth, indicates a need for immediate medical attention. Waiting for an hour could lead to worsening of the child's condition.

A. Apply warm, moist compresses to the neck area:

Warm, moist compresses are not typically used in the postoperative care of a tonsillectomy. Cold compresses or ice packs may be recommended to reduce swelling.

B. Observe for excessive swallowing:

Excessive swallowing may indicate bleeding, and close monitoring for any signs of bleeding is important.

C. Provide liquid acetaminophen with codeine as ordered:

Pain management is crucial postoperatively, and providing pain medication as ordered helps ensure the child's comfort.

D. Place the child in a partially prone position with the head turned to one side in the immediate post-operative period:

This position helps facilitate drainage and reduce the risk of aspiration. However, the specific positioning may vary based on the surgeon's preference.

E. Offer orange juice, lemonade, or milk to drink once awake and alert:

Citrus juices and milk are usually avoided in the immediate postoperative period to prevent irritation to the surgical site. Clear fluids or those recommended by the healthcare provider are typically introduced gradually.