A nurse is caring for a preschooler who is terminally ill.
Which of the following reactions to death should the nurse expect?

Choice A rationale

Daily weights are primarily used for fluid balance monitoring, especially in cases like heart failure or renal conditions. It is not a standard intervention unless specifically indicated for the child’s clinical condition.

Choice B rationale

Routine blood pressure checks every 8 hours are not typically necessary for pediatric patients unless there is a concern for hypertension or critical illness. This intervention is not universally applicable.

Choice C rationale

Seizure precautions are crucial for ensuring patient safety in children with a history or risk of seizures. They include measures such as padded side rails, oxygen availability, and maintaining a safe environment.

Choice D rationale

Sodium-restricted diets are not routinely prescribed for children unless there is an underlying condition like kidney or cardiac disease. This intervention does not apply broadly to pediatric care.

Choice A rationale

Rhinorrhea is a common manifestation of respiratory syncytial virus (RSV), as the virus causes inflammation of the upper respiratory mucosa leading to excessive nasal secretions. This inflammation and increased mucus production are the body's defensive response to eliminate the virus. The condition is most prevalent during early stages of infection and is often accompanied by other symptoms like cough and fever. The absence of other options makes rhinorrhea a characteristic feature in RSV.

Choice B rationale

Vesicles on the trunk are typically associated with varicella-zoster virus (chickenpox), not RSV. Vesicles form as the virus infects epithelial cells, leading to fluid-filled lesions that eventually crust over. This clinical presentation is entirely unrelated to the respiratory symptoms caused by RSV, which targets the respiratory epithelial cells rather than the skin.

Choice C rationale

Barrel chest develops as a chronic adaptation in diseases like emphysema and cystic fibrosis, where prolonged air trapping occurs. RSV predominantly affects younger children acutely, resulting in symptoms like rhinorrhea, cough, and wheezing without long-term anatomical alterations like barrel chest.

Choice D rationale

Clubbing of the fingers arises in chronic conditions like congenital heart disease or cystic fibrosis due to prolonged hypoxia and tissue growth factors affecting the nails. RSV is an acute respiratory virus, unlikely to lead to chronic hypoxia causing clubbing.