A nurse working in an inpatient pediatric unit is caring for a 9-year-old child who has a gastrointestinal (GI) bleed and is experiencing weakness.
Which of the following nursing actions reflects the safe and therapeutic use of play in the care of this client?

Planning care for Duchenne muscular dystrophy involves applying knowledge of its progressive, X-linked recessive nature. Understanding the typical trajectory of muscle degeneration, including respiratory and cardiac involvement, is necessary to anticipate complications and provide appropriate multidisciplinary support.

Choice A rationale

Duchenne muscular dystrophy is a progressive, degenerative disease caused by the absence of dystrophin. It does not improve over time; instead, muscle weakness inevitably worsens as muscle fibers are gradually replaced by fat and connective tissue throughout the child's life.

Choice B rationale

Cognitive impairment in Duchenne muscular dystrophy is related to the absence of certain dystrophin isoforms in the brain. Unlike motor skills, these cognitive deficits are usually non-progressive, but they do not typically improve significantly through intensive physical or medical therapy.

Choice C rationale

Children with Duchenne muscular dystrophy may experience oropharyngeal muscle weakness and cognitive delays that affect speech. Planning must account for these communication barriers to ensure the child can express needs and participate in their care as the disease progresses.

Choice D rationale

Mobility concerns in Duchenne muscular dystrophy typically arise in early childhood, often between ages three and five. Most children require a wheelchair by age twelve. Mobility issues do not wait until adulthood but are a hallmark of early disease progression..

Management of infective endocarditis involves strict adherence to prophylactic protocols. This scenario requires an understanding of American Heart Association guidelines regarding antibiotic administration. Knowledge of the specific procedures that trigger high-risk bacteremia is necessary to provide accurate education to patients and families.

Choice A rationale

Endocarditis is a bacterial infection of the endothelial lining, not a viral respiratory illness. Flu season does not dictate the timing of antibiotic prophylaxis. Prevention is focused on preventing bacteremia during invasive procedures that disrupt mucosal surfaces.

Choice B rationale

Daily antibiotic use is not recommended for endocarditis prophylaxis because it increases the risk of antibiotic resistance. Continuous administration does not provide targeted protection against the transient bacteremia caused by specific invasive medical or dental manipulations.

Choice C rationale

Children with certain congenital heart defects, especially those with prosthetic valves or unrepaired cyanotic lesions, are at the highest risk. Claiming prophylaxis is unnecessary is scientifically incorrect and places the patient at risk for sepsis.

Choice D rationale

Current guidelines specify that high-risk patients require prophylaxis only before procedures involving manipulation of gingival tissue or the periapical region of teeth. This targeted approach prevents Streptococcus viridans from entering the bloodstream and colonizing heart valves..