A nurse is collecting data from a school-age child who has Cushing's syndrome.
Which of the following findings should the nurse expect?

Choice A rationale

A hot spot on the cast indicates localized warmth, which is a common sign of infection. The presence of a hot spot suggests that there might be an underlying infection beneath the cast, potentially requiring medical intervention. It is important to monitor for signs of infection to prevent complications and ensure proper healing of the fracture.

Choice B rationale

Pruritus, or itching, under the cast is a common discomfort experienced by patients with casts. It is usually due to dry skin or irritation but is not typically a sign of infection. While pruritus can be bothersome, it does not indicate an infectious process and can be managed with appropriate skin care.

Choice C rationale

General edema of the toes can occur due to prolonged immobility or dependency of the limb. While it can indicate impaired circulation or venous return, it is not specific to infection. Generalized edema requires monitoring but is not a definitive sign of infection within the cast.

Choice D rationale

Pain at the fracture site is expected after a fracture and can be managed with analgesics and proper cast care. Persistent or worsening pain might indicate complications such as improper cast fit or delayed healing, but it is not a specific sign of infection. Pain management and follow-up are essential for recovery.

Choice C rationale

Hives on the child's neck is the priority finding because it can indicate an allergic reaction, which may progress to anaphylaxis. Anaphylaxis is a severe, life-threatening allergic reaction that requires immediate intervention. Hives are often the first sign of an allergic reaction and can quickly escalate to airway obstruction, difficulty breathing, and cardiovascular collapse. Early identification and treatment of an allergic reaction can prevent these severe complications. The nurse should be prepared to administer emergency medications, such as epinephrine, and provide respiratory support if needed.

Choice A rationale

Redness at the injection site is a common and expected local reaction following immunization. It typically resolves on its own without intervention. While it may cause some discomfort, it does not pose an immediate threat to the child's health and is not a priority over signs of a potential allergic reaction.

Choice B rationale

A temperature of 37.7°C (99.9°F) is a mild fever and a common response to immunizations as the body mounts an immune response. It is not usually cause for concern and can be managed with antipyretics if necessary. This mild fever does not indicate an urgent condition compared to the signs of an allergic reaction.

Choice D rationale

Prolonged crying can be a sign of discomfort or pain following an immunization but is not necessarily indicative of a severe reaction. It is important to assess the child's overall condition and provide comfort measures. However, it does not take precedence over signs of an allergic reaction, which require immediate attention.