A nurse is educating parents about essential dietary modifications for their child, who has recently been diagnosed with celiac disease.

Which foods should the nurse include in the list of permissible foods for this child?

Choice A rationale
While it’s true that TSH levels can influence thyroxine levels, this statement is misleading. High TSH levels do not cause low thyroxine levels. Instead, the pituitary gland produces more TSH when thyroxine levels are low in an attempt to stimulate the thyroid gland to produce more thyroxine.
Choice B rationale
Thyroxine levels in breastfeeding infants should be within the normal range. High thyroxine levels are not typical and could indicate a problem with the infant’s thyroid gland.
Choice C rationale
This statement is incorrect. The thyroid gland begins producing thyroxine before birth, and levels should be within the normal range shortly after birth.
Choice D rationale
This is the correct explanation. In congenital hypothyroidism, the thyroid gland does not produce enough thyroxine, leading to high levels of TSH. The pituitary gland produces more TSH in an attempt to stimulate the thyroid gland to produce more thyroxine.

Choice A rationale
Using a disposable moist wipe to remove eye crusts can be helpful, but it’s not the most important instruction for caregivers. The crusts are a symptom of the infection, and while removing them can make the child more comfortable, it doesn’t address the underlying issue.
Choice B rationale
When using an ophthalmic anti-infective ointment, it is important to prepare the child for blurry vision after ointment application. This is because the ointment can temporarily blur vision after application. It is important to follow the instructions on the medication label and continue using the ointment for the full course of treatment, even if symptoms improve before then.
Choice C rationale
While it’s important to keep the eye area clean, wiping towards the opposite eye could potentially spread the infection. Therefore, this is not the best advice for caregivers.
Choice D rationale
Discontinuing the ointment once drainage resolves could lead to an incomplete treatment of the infection. It’s crucial to use the ointment for the full course of treatment as prescribed by the healthcare provider, even if symptoms seem to improve.