A nurse is caring for a toddler admitted to the hospital.

Exhibits

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Body system	Findings
Respiratory	Respiratory rate 26/min
Cardiovascular	Heart rate 112/min Capillary refill 4 seconds
Gastrointestinal	Hyperactive bowel sounds
Integumentary	Diaper area reddened Extremities cool Reports no tears
Neurologic	Lethargic

Rationale for Correct Choices

• Give iron with vitamin C to increase absorption: Vitamin C enhances the solubility and bioavailability of iron, which is especially important for a child on a vegetarian diet where non-heme iron predominates. Taking iron with citrus juice or ascorbic acid reduces the risk of poor absorption and supports correction of anemia.

• Give iron through a straw to prevent staining of teeth: Liquid iron supplements can cause temporary discoloration of tooth enamel. Using a straw minimizes direct contact of iron with the teeth, helping to preserve dental appearance while ensuring the child still receives the full dose.

• Increase intake of iron-rich foods such as beans, leafy greens, and fortified cereals: A vegetarian child should be encouraged to consume a variety of non-heme iron foods. Combining these with vitamin C sources improves absorption and supports bone marrow production of healthy red blood cells.

Rationale for Incorrect Choices

• Give iron with milk to reduce stomach upset: Milk contains calcium and casein, both of which inhibit iron absorption, reducing the effectiveness of therapy.

• Administer iron on an empty stomach with no fluids: Iron is best absorbed on an empty stomach, but giving it without fluids increases gastric irritation and may cause poor adherence in children.

• Encourage brushing with baking soda after iron administration: Baking soda is abrasive and not recommended for children, as it may damage developing enamel while not significantly reducing iron staining.

• Mix iron with milk to reduce metallic taste: Mixing with milk impairs absorption, worsening anemia, and undermines the therapeutic purpose of supplementation.

• Restrict protein sources to avoid overworking bone marrow: Protein is essential for hemoglobin synthesis and red blood cell production; restricting it would worsen the child’s anemic state.

• Reduce iron-containing foods until medication is completed: Limiting dietary iron would prevent recovery from anemia and contradicts the goal of maximizing iron intake during supplementation.

A. Sunken anterior fontanel: A sunken fontanel is typically associated with dehydration, not increased intracranial pressure. In the case of a subdural hematoma, the anterior fontanel would more likely be bulging due to pressure buildup.

B. Vomiting: Increased intracranial pressure from a subdural hematoma can stimulate the vomiting center in the brain. Vomiting is a common expected finding and serves as an important clinical indicator of worsening pressure.

C. Pinpoint pupils: Pinpoint pupils are usually linked to opioid intoxication or pontine brainstem injury, not subdural hematoma. In hematomas, pupils are more likely to become unequal or sluggishly reactive as intracranial pressure increases.

D. Hypertonia: While changes in muscle tone can occur with neurological injury, hypertonia is not the most specific or expected finding in infants with subdural hematoma. Vomiting is a more consistent and direct indicator of increased intracranial pressure.