A nurse is assisting in the care of a 3-year-old preschool child who has extreme manifestations of lead poisoning. Which of the following actions should the nurse perform first?

A. Atrial fibrillation on the cardiac monitor. Rheumatic fever can cause carditis, but atrial fibrillation is not a typical finding. Instead, valvular damage, tachycardia, or murmurs are more commonly observed.

B. Elevated BUN and creatinine on morning laboratory results. Rheumatic fever primarily affects the heart, joints, skin, and brain, not the kidneys. Elevated BUN and creatinine are more indicative of post-streptococcal glomerulonephritis, a separate complication of streptococcal infection.

C. Involuntary movements of extremities. Sydenham’s chorea, characterized by involuntary, jerky movements, is a classic neurologic manifestation of rheumatic fever. It results from inflammation affecting the basal ganglia of the brain.

D. Alopecia. Rheumatic fever does not cause alopecia. Hair loss is more commonly associated with autoimmune diseases such as lupus, not post-streptococcal complications.

E. Report of chest pain. Chest pain can indicate carditis, a major criterion for rheumatic fever. Inflammation of the heart's endocardium, myocardium, or pericardium may lead to pain, murmurs, or heart failure symptoms.

F. Oliguria. Decreased urine output is more commonly seen in post-streptococcal glomerulonephritis rather than rheumatic fever, as rheumatic fever primarily affects the heart, joints, and nervous system.

A. "As a nurse, I can't diagnose what is causing you to have worsening symptoms. However, we will relay this information to your healthcare provider so they can determine what should happen next." While it is true that nurses cannot diagnose, this response does not address the adolescent’s concerns or encourage them to share more information about their symptoms.

B. "If you are experiencing worsening respiratory distress, we must get you to the emergency department immediately." This response may create unnecessary alarm without first assessing the severity of the symptoms. While severe distress requires urgent care, the nurse should first gather more information.

C. "It sounds like you may be concerned that your condition could be getting worse. That can be scary—tell me more about what you have been experiencing." This is correct because it acknowledges the adolescent's emotions, encourages open communication, and allows the nurse to gather more information before determining the appropriate course of action.

D. "As you know, cystic fibrosis is a respiratory disease. Increased respiratory distress is a characteristic symptom of this disorder." While this statement is factually correct, it dismisses the adolescent’s concern instead of providing reassurance, emotional support, and further assessment.