A nurse is reviewing potential provider's orders for a client.
For each potential provider's order, click to specify if the potential order is expected or unexpected for the client.

Choice A rationale

Excessive milk intake in a toddler can lead to iron-deficiency anemia because milk is a poor source of iron and can fill the child's stomach, leading to a decreased appetite for iron-rich solid foods. The toddler's high consumption of milk (946 mL) significantly exceeds the recommended daily intake, which should be around 480-720 mL, thereby displacing other nutritionally essential foods.

Choice B rationale

Vitamin A toxicity is typically associated with excessive intake of vitamin A supplements or foods fortified with high levels of vitamin A, such as liver. While milk is fortified with vitamin A, consuming 946 mL daily is not enough to cause toxicity, as the quantity of vitamin A per serving is relatively low. The toddler's diet is more likely to be deficient in other nutrients due to the milk intake.

Choice C rationale

Impaired carbohydrate metabolism is not a direct consequence of consuming a high volume of whole milk. This condition, such as galactosemia, is a genetic disorder where the body cannot properly metabolize simple sugars. While milk contains lactose (a carbohydrate), this level of consumption does not cause impaired metabolism unless an underlying genetic condition is present.

Choice D rationale

Lactose intolerance is a condition where the body cannot digest lactose due to a deficiency in the lactase enzyme. If the toddler had lactose intolerance, they would likely present with gastrointestinal symptoms like diarrhea, gas, and abdominal pain after consuming milk. The question states the toddler has a poor appetite, not symptoms of intolerance.

Choice A rationale

Passive range-of-motion exercises are contraindicated during an acute hemarthrosis episode. Movement can exacerbate bleeding within the joint and cause further pain and damage to the synovial tissue and cartilage. The scientific rationale is to immobilize the affected joint to stop the bleeding and allow the clotting factors to work effectively. Gentle range of motion is only introduced later, during the rehabilitation phase.

Choice B rationale

Administering aspirin is a dangerous and contraindicated choice for a child with hemophilia. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1 (COX-1) and COX-2 enzymes, thereby increasing the risk of bleeding. This can worsen the hemarthrosis. Acetaminophen or non-aspirin NSAIDs like ibuprofen are preferred for pain management in these patients.

Choice C rationale

Placing ice packs on the affected joints is the correct scientific intervention. Cold application, or cryotherapy, causes vasoconstriction, which helps to slow or stop the bleeding into the joint space. This reduces swelling, inflammation, and pain associated with hemarthrosis. The RICE acronym (rest, ice, compression, elevation) is a scientifically validated acute management strategy for joint bleeds in hemophilia.

Choice D rationale

Positioning the lower extremities below the level of the heart is scientifically incorrect. The affected extremity should be elevated above the level of the heart. Elevation uses gravity to reduce blood flow to the joint, which helps to decrease swelling, pain, and bleeding. Placing the extremity below the heart would increase blood flow and exacerbate the hemarthrosis, increasing intra-articular pressure and pain.