A nurse is caring for a visually impaired 10-year-old child. The nursing intervention with the highest priority during the admission process would be:

Choice A reason: Placing an infant on the stomach for sleep increases the risk of sudden infant death syndrome (SIDS) and does not effectively manage GERD. Upright positioning after feeding is preferred to reduce reflux by aiding gastric emptying, making this an incorrect and unsafe practice for GERD management.

Choice B reason: Frequent burping during feedings reduces air swallowed by the infant, decreasing gastric pressure and minimizing reflux episodes in GERD. This practice helps prevent stomach contents from flowing back into the esophagus, aligning with effective management strategies, making it a correct parental understanding of care.

Choice C reason: Keeping the infant upright for 30 minutes after feedings uses gravity to prevent stomach contents from refluxing into the esophagus, reducing GERD symptoms. This is a standard recommendation for managing infant GERD, as it promotes gastric emptying, making this a correct parental statement.

Choice D reason: Large, infrequent feedings increase gastric volume and pressure, exacerbating GERD by promoting reflux of stomach contents into the esophagus. Smaller, more frequent feedings are recommended to minimize reflux, making this statement incorrect and indicating a misunderstanding of GERD management principles.

Choice E reason: Small, frequent feedings reduce gastric distension, lowering the pressure that can cause reflux in infants with GERD. This approach allows better digestion and lessens esophageal irritation, aligning with standard care recommendations, making it a correct statement reflecting parental understanding of GERD management.

Choice A reason: Obtaining a detailed history is important to identify the ingested substance, but it is not the first priority in a lethargic child. Lethargy may indicate compromised airway, breathing, or circulation, which are life-threatening. Addressing immediate physiological stability takes precedence over history collection in an emergency setting.

Choice B reason: Obtaining vital signs and assessing perfusion is critical in evaluating a child with potential poisoning, but it is secondary to ensuring airway and breathing stability. Lethargy may signal respiratory depression or hypoxia, which require immediate assessment to prevent further deterioration before vital signs are fully evaluated.

Choice C reason: Assessing the child’s airway and breathing is the first priority in a lethargic child with suspected ingestion. Lethargy may indicate central nervous system depression or hypoxia, which can compromise airway patency and respiratory function. Immediate assessment ensures life-threatening conditions are addressed first, following the ABCs (airway, breathing, circulation) of emergency care.

Choice D reason: Administering activated charcoal may be appropriate to prevent absorption of certain toxins, but it is not the first priority. Without ensuring airway and breathing stability, charcoal administration could be unsafe, especially if the child is lethargic and at risk for aspiration, making this a secondary intervention.