A nurse is caring for a client who is receiving mannitol for increased intracranial pressure. The nurse should identify which of the following findings as an adverse effect of this medication?

Rationale:

A. Provide nasotracheal suctioning for the adolescent every 4 hr: Routine suctioning can increase intracranial pressure (ICP) due to stimulation of the airway. It should only be done when absolutely necessary and performed with caution in clients with elevated ICP.

B. Place the adolescent on contact precautions for 48 hr: Bacterial meningitis requires droplet precautions, not contact precautions. Droplet precautions should be maintained until 24 hours after the initiation of effective antibiotic therapy, not strictly for 48 hours.

C. Perform passive range-of-motion exercises for the adolescent prior to administering sedation: While mobility is important, performing exercises before sedation is not a priority intervention when managing increased ICP. Activity may actually raise ICP, so it should be limited during the acute phase.

D. Maintain the head of the adolescent's bed at a 20° angle: Elevating the head of the bed helps promote venous return from the brain and reduces ICP. Keeping the head midline and the bed slightly elevated is a key intervention in managing clients with increased ICP.

Rationale:

A. "Administer a daily multivitamin to your child along with this medication.": Children with cystic fibrosis often have malabsorption of fat-soluble vitamins (A, D, E, and K) due to pancreatic insufficiency. A multivitamin supplement helps prevent deficiencies, and it's commonly recommended alongside pancreatic enzyme therapy.

B. "Give the medication immediately after giving an antacid to your child.": Antacids can interfere with the effectiveness of pancrelipase by altering the pH needed for the enzymes to function properly in the duodenum.

C. "Monitor your child's weight every 6 months while taking this medication.": Weight in children with cystic fibrosis should be monitored more frequently due to the high risk of malnutrition and poor growth. Waiting six months could delay detection of nutritional issues.

D. "Ensure that this medication is taken 1 hour after meals.": Pancrelipase must be taken with meals and snacks to ensure that digestive enzymes are available when food is present in the small intestine. Delaying the dose reduces its effectiveness in nutrient absorption.