A nurse is teaching the guardian of a 5-year-old child who has encopresis about management of the condition.
Which of the following statements by the guardian indicates an understanding of the teaching?

The correct answer is choice c. Sunken anterior fontanel.

Choice A rationale:

A heart rate of 162/min in a 2-month-old infant can be within the upper range of normal, especially if the infant is crying or agitated. While it is important to monitor, it is not the most critical finding in this context.

Choice B rationale:

A negative doll’s eye reflex (oculocephalic reflex) can indicate neurological issues, but it is not directly related to heart failure or the administration of furosemide.

Choice C rationale:

A sunken anterior fontanel indicates dehydration, which is a critical concern for an infant receiving furosemide, a diuretic that can lead to significant fluid loss. Dehydration can exacerbate heart failure and lead to severe complications.

Choice D rationale:

A potassium level of 5.1 mEq/L is slightly elevated but not immediately life-threatening. It requires monitoring and potential intervention but is not the most urgent issue compared to dehydration.

Monitoring for dehydration is crucial in infants on diuretics like furosemide, making the sunken anterior fontanel the priority finding.

Choice A rationale

While it’s important for a child to have adequate sleep, waiting until the child indicates that they are tired before putting them to bed may not be the best approach. Children often do not recognize their own signs of fatigue and may become overtired, which can actually make it more difficult for them to fall asleep and stay asleep.

Choice B rationale

Allowing a child to watch an animated movie before bedtime may seem like a harmless routine, but it can actually interfere with their sleep. The light from the screen can suppress the production of melatonin, the hormone that regulates sleep, and the content of the movie can be stimulating rather than relaxing.

Choice C rationale

Waking your child up during a night terror can be beneficial. Night terrors occur during the deepest stages of sleep and can be frightening for both the child and the parents. By gently waking your child before the usual time of a night terror, you can interrupt the sleep cycle and potentially prevent the night terror from occurring.

Choice D rationale

While it may be tempting to allow your child to sleep in your bed, especially if they are experiencing night terrors, this is not typically recommended. Co-sleeping can create a dependency and make it more difficult for the child to learn to self-soothe and fall asleep independently.