A school-aged child is admitted to the hospital with a diagnosis of acute rheumatic fever. In obtaining a health history from the child's parent, the recent occurrence of which illness is most significant?

Choice A reason: Obtaining the child's 3-day diet history based on the mother's input is a useful intervention to assess the child's nutritional intake and identify any unhealthy eating habits or patterns. The nurse can use the diet history to provide individualized and evidence-based dietary advice and counseling to the mother and the child, such as reducing the intake of sugar-sweetened beverages, increasing the intake of fruits and vegetables, and limiting the portion sizes.

Choice B reason: Explaining that the child is likely to grow into her weight is not a helpful intervention and may be misleading or harmful. It may give the mother and the child a false sense of reassurance and discourage them from making any lifestyle changes. It may also ignore the potential health risks and psychosocial consequences of childhood obesity, such as diabetes, hypertension, low self-esteem, and bullying.

Choice C reason: Telling the mother that girls hit their growth spurt before boys so eating more is expected is not a valid intervention and may be inaccurate or inappropriate. It may imply that the child's obesity is normal or inevitable, which is not true. It may also overlook the fact that the child's weight and height are disproportionate and do not match the growth charts for her age and gender.

Choice D reason: Inquiring as to whether or not the school has a physical education program is not a sufficient intervention and may be irrelevant or ineffective. It may not address the child's specific physical activity needs and preferences, or the barriers and facilitators to physical activity in the home and community settings. It may also shift the responsibility and accountability from the mother and the child to the school.

Choice E reason: Determining the child's usual physical activity pattern is a beneficial intervention to evaluate the child's energy expenditure and identify any sedentary behaviors or activities. The nurse can use the physical activity pattern to provide individualized and evidence-based physical activity recommendations and guidance to the mother and the child, such as increasing the frequency, intensity, and duration of moderate to vigorous physical activity, reducing the screen time, and engaging in fun and enjoyable physical activities..

Choice A reason: Encouraging the parent to come to the clinic if the child develops a fever is not the best response that the nurse can give. This is because a fever may indicate a serious infection, such as Lyme disease, that requires prompt treatment. The nurse should not wait for the child to develop a fever before advising the parent to seek medical attention.

Choice B reason: Instructing the parent to apply an antihistamine ointment for one week is not the best response that the nurse can give. This is because an antihistamine ointment may not be effective for a fungal infection, such as ringworm, or a bacterial infection, such as Lyme disease, that may cause a circular rash. The nurse should not recommend any OTC product without knowing the exact cause of the rash.

Choice C reason: Offering reassurance that OTC corticosteroid creams are safe and effective is not the best response that the nurse can give. This is because corticosteroid creams may worsen a fungal infection, such as ringworm, or mask the symptoms of a bacterial infection, such as Lyme disease, that may cause a circular rash. The nurse should not recommend any OTC product without knowing the exact cause of the rash.

Choice D reason: Explaining the need for the child to have an immediate medical evaluation is the best response that the nurse can give. This is because a circular rash can be a sign of a serious condition, such as Lyme disease, that requires urgent diagnosis and treatment. The nurse should inform the parent that the rash may not be ringworm, as many people assume, and that it may be caused by a tick bite or another factor. The nurse should also advise the parent to avoid touching or scratching the rash and to keep it clean and dry until the child sees a doctor.