A nurse is caring for a client with a plaster hip spica cast. What measure would best protect the cast from being soiled by urine and feces?

Choice A rationale:

Pancreatic enzymes are used to aid in digestion and are not known to interact significantly with serum creatinine levels. Therefore, they are unlikely to be contraindicated based solely on an elevated serum creatinine level.

Choice B rationale:

Gentamicin is an aminoglycoside antibiotic that is primarily eliminated by the kidneys. Elevated serum creatinine levels indicate potential renal impairment, which could lead to reduced drug clearance and an increased risk of gentamicin toxicity, including nephrotoxicity and ototoxicity. Consulting the health care provider before administering gentamicin is important to ensure the appropriateness of the medication dosage and regimen.

Choice C rationale:

Albuterol is a bronchodilator commonly used to treat respiratory conditions. Serum creatinine levels are not directly related to albuterol administration. It is unlikely that an elevated serum creatinine level would significantly affect the administration of albuterol.

Choice D rationale:

Carbenicillin is an antibiotic that is excreted through the kidneys. While renal function may impact the dosing of carbenicillin, an elevated serum creatinine level alone may not necessarily warrant consultation with the health care provider. Other factors such as the severity of renal impairment and the patient's overall condition would need to be considered.

Choice A rationale:

Returning to the hospital if the child spits up blood is a correct response as it indicates the recognition of potential postoperative bleeding.

Choice B rationale:

Giving the child cherry gelatin, even though it's the child's favorite, might not be appropriate after a tonsillectomy/adenoidectomy, as certain foods can irritate the healing throat.

Choice C rationale:

Returning to the hospital if the child develops difficulty breathing is a necessary step to address any respiratory distress.

Choice D rationale:

Having the child rinse her mouth frequently with water to prevent a bad breath odor is a suitable suggestion to maintain oral hygiene and comfort after surgery. In all three scenarios, the rationale for the correct answers revolves around patient safety, comfort, and appropriate post-operative care. The incorrect choices in each question either introduce potential complications, misunderstandings, or actions that might compromise the patient's well-being.