A nurse is providing teaching to an adolescent who has vulvovaginitis. Which of the following statements should the nurse include in the teaching?

A. Auscultate the abdomen for at least 1 min if bowel sounds are absent: If bowel sounds are absent, the nurse should listen for a full 5 minutes before determining true absence. Listening for only 1 minute may lead to an inaccurate conclusion.

B. Observe abdominal movement to determine the respiratory rate: Abdominal movement is observed for respiratory assessment in infants and younger children. By adolescence, chest movement is more reliable for assessing respiratory rate.

C. Use the FACES scale to assess pain: The FACES scale is typically used for younger children who may struggle with numeric rating scales. A 13-year-old adolescent can generally use a numeric scale (0–10) for accurate self-reporting of pain.

D. Have the child bend forward at the waist and check for asymmetry of the scapula: This is an appropriate screening method for scoliosis in adolescents. Bending forward allows the nurse to detect uneven shoulders, hips, or scapulae, which are common indicators of spinal curvature.

• Keep adolescent flat in bed for 24 hr post lumbar puncture: Extended flat bed rest is not recommended after lumbar puncture, as it does not prevent spinal headache and can increase discomfort. Instead, the adolescent may be kept supine only briefly for observation.

• Place the adolescent on a cooling blanket: While the adolescent has a fever of 39° C (102.2° F), a cooling blanket can cause the body to shiver, which can increase metabolic rate and raise the core temperature. A safer method is the administration of antipyretic medications like acetaminophen.

• Administer IV acyclovir: IV acyclovir is indicated for viral meningitis, particularly caused by herpes simplex virus. This adolescent’s presentation, CSF findings (low glucose, high protein, high WBC), and purpuric rash point toward bacterial meningitis, not viral etiology, making acyclovir inappropriate here.

• Place the adolescent on seizure precautions: The adolescent has developed seizure activity with tonic-clonic features, cyanosis, and pooling secretions. Seizure precautions are essential to protect from aspiration and injury, with measures such as padded side rails, suction readiness, and airway support.

• Administer IV cefotaxime: Cefotaxime is a broad-spectrum antibiotic effective against common bacterial meningitis pathogens. Given the cloudy CSF, elevated WBC, low glucose, and rapid deterioration, immediate administration of IV antibiotics is the standard, lifesaving intervention.

• Insert a peripheral IV catheter: IV access is necessary to administer fluids, antibiotics, and emergency medications. The adolescent is also showing signs of sepsis and hypotension (BP 88/50 mmHg), so fluid resuscitation and supportive therapy via IV are vital.