A nurse on an oncology unit is assessing a child who has a brain tumor. Which of the following findings should the nurse expect?

Choice A reason: Offering the client a reward for agreeing to the treatment is not an appropriate action, as it does not respect the client's autonomy and may be seen as coercive or manipulative.

Choice B reason: Notifying the provider of the client's refusal and documenting it in the chart is a necessary action, but not the first one. The nurse should first attempt to educate the client and the parent and address their concerns and preferences.

Choice C reason: Initiating the treatment as per the parent's request and the provider's order is not an appropriate action, as it violates the client's right to informed consent and may cause harm or resentment.

Choice D reason: Educating the client and the parent about the benefits and risks of the treatment is the best action, as it provides them with the information they need to make an informed decision and shows respect for their values and beliefs.

The correct answer is: b.

Choice A: Heart rate 130/min

A heart rate of 130 beats per minute (bpm) is considered high for a 3-year-old child. Normal heart rates for children aged 1-3 years typically range from 80 to 120 bpm. While dehydration can cause tachycardia (increased heart rate), a heart rate of 130 bpm does not necessarily indicate effective rehydration.

Choice B: Urine specific gravity 1.015

Urine specific gravity of 1.015 is within the normal range (1.005–1.030) for a hydrated child. Dehydration increases urine concentration (>1.020), but a normalized value like 1.015 shows that ORT has restored fluid balance. UpToDate and NIH studies (e.g., Binder et al., 2014) highlight urine specific gravity as a precise measure of hydration status, making it the strongest indicator of ORT effectiveness.

Choice C: Respiratory rate 24/min

The normal respiratory rate for a 3-year-old child is between 20 and 30 breaths per minute. A respiratory rate of 24 breaths per minute is within this normal range. While a normal respiratory rate can indicate improved hydration status, it is not the most specific indicator of effective rehydration therapy.

Choice D: Capillary refill less than 3 seconds

Capillary refill time of less than 3 seconds suggests adequate perfusion, as normal is under 2 seconds. Dehydration may prolong this time, but “less than 3 seconds” could include slightly delayed values (e.g., 2.5 seconds). UpToDate and NIH studies (e.g., Doan et al., 2010) note it as useful but less specific than urine specific gravity for confirming ORT effectiveness.