A nurse is providing education to the family of a child who has infectious endocarditis. Which of the following statements made by the nurse is accurate regarding this condition?

Rationale:

• Nutrition: Millie’s intake of 5–6 cups of low-fat milk per day significantly exceeds the recommended 2 cups for toddlers. High milk intake suppresses appetite for nutrient-dense foods, worsening her picky eating and risking iron-deficiency anemia. Because it directly affects growth and development, nutrition becomes the priority teaching need.
• Excessive milk intake: Drinking this much milk can displace iron-rich solids, creating micronutrient deficits and contributing to poor weight progression if continued. Excess milk can also cause constipation and limit overall diet variety in young children. This factor presents the most immediate risk and therefore requires primary intervention.
• Language: Millie’s use of two-word phrases is developmentally appropriate for age 2, even though she is not yet forming full sentences. Sentence formation typically matures between ages 2½ and 3, making this delay mild and expected in many toddlers.
• Not using complete sentences: Toddlers commonly have uneven language development, and sentence construction often emerges later in the third year. This pattern does not impair Millie’s daily functioning or pose a health threat. Because the concern is mild and age-appropriate, it does not outweigh the need to address excessive milk intake.
• Motor skills: Millie walks, runs, kicks a ball, and climbs stairs with help—all well within expected developmental ranges for a 2-year-old. Fine motor tasks such as switching from a palmar grasp to a mature tripod grasp do not emerge until closer to age 3. These findings do not require urgent correction.
• Holding pencil in fist and needing help to walk up stairs: A fist grasp is the normal toddler way of holding writing tools, and alternating feet on stairs often develops after age 3. These abilities reflect early-stage coordination that continues to mature gradually. They do not signal a developmental risk.
• Behavior: Saying “no,” imitating adults, and having 2–3 tantrums per week are classic expressions of toddler autonomy. These behaviors demonstrate normal emotional development and do not indicate dysregulation that threatens health or safety.
• Having a tantrum 2–3 times per week: Tantrums at this frequency fall squarely within expected toddler patterns as they manage frustration and communication limits. They usually decrease as language improves and routines stabilize. Because they represent normal development, they are not the primary concern.

Rationale:

A. "Ensure you get adequate rest and stay hydrated until you feel better.": Rest and hydration are the cornerstone of managing mononucleosis, as the illness is viral and self-limiting. Adequate rest supports immune function, and maintaining hydration helps manage fever, sore throat, and fatigue, promoting recovery without the need for antiviral medications.

B. "Avoid active or contact sports for 1 week.": Avoiding contact sports is important due to the risk of splenic rupture from hepatosplenomegaly; however, the restriction usually lasts at least 3–4 weeks or until the spleen is no longer enlarged.

C. "Avoid taking any over-the-counter medications like ibuprofen.": Over-the-counter medications such as acetaminophen or ibuprofen may be used to relieve fever and discomfort, provided there are no contraindications. Advising complete avoidance could unnecessarily limit symptom management and is not standard discharge teaching.

D. "Be sure to complete the entire course of antibiotics.": Antibiotics are not indicated for mononucleosis because it is caused by the Epstein-Barr virus, not bacteria. Prescribing antibiotics unnecessarily can lead to adverse reactions, such as rash, and is not part of proper discharge teaching.