A school nurse is assessing the visual acuity of a school-age child. Which of the following findings indicate that the child should be evaluated for strabismus?

A. "Apply a dry gauze dressing twice per day."

This instruction may not be necessary for a hypospadias repair procedure. Typically, the surgical site will have a dressing applied immediately after the surgery, but ongoing dressing changes may not be required once the infant is discharged. It's essential to follow the specific postoperative care plan provided by the healthcare provider.

B. "Perform hourly measurements of the infant's urinary output."

Hourly measurements of urinary output may not be necessary unless specifically instructed by the healthcare provider due to concerns such as urinary retention or dehydration. However, regular monitoring of urinary output as part of routine care may be appropriate.

C. "Offer the infant 12 to 18 ounces of fruit juice daily."

Offering 12 to 18 ounces of fruit juice daily to a 6-month-old infant is not recommended. Introduction of fruit juice should be gradual and in small amounts, following guidance from healthcare providers and infant nutrition guidelines. Excessive fruit juice consumption can lead to gastrointestinal issues and may not be suitable for all infants.

D. "Avoid giving the infant a tub bath until the stent is removed."

This instruction is appropriate. After hypospadias repair surgery, a stent or catheter may be placed to aid in healing and ensure proper urine drainage. It's essential to follow healthcare provider instructions regarding bathing and hygiene to minimize the risk of infection and to ensure the stent remains in place until it is ready to be removed.

A. "Avoid immunizing your child with the meningococcal vaccine."

This statement is incorrect. Children with sickle cell anemia are at increased risk of infections, including meningococcal disease. Immunization with the meningococcal vaccine is recommended to help prevent this serious infection.

B. "Restrict the time your child spends playing outdoors."

While it's important for children with sickle cell anemia to avoid extreme temperatures and stay hydrated to prevent triggering a vaso-occlusive crisis, completely restricting outdoor playtime may not be necessary. It's essential to encourage appropriate hydration and dress warmly in cold weather but allowing outdoor play in moderation can be beneficial for physical activity and socialization.

C. "Increase your child's intake of oral fluids."

This is a correct statement. Adequate hydration is crucial for children with sickle cell anemia to help prevent vaso-occlusive crises and maintain overall health. Increasing oral fluid intake, particularly water, can help prevent dehydration and promote circulation of sickle-shaped red blood cells.

D. "Provide your child with a high-protein diet."

This is also a correct statement. A diet rich in high-quality protein can help support healthy growth and development in children with sickle cell anemia. Protein is important for building and repairing tissues, including red blood cells. However, it's essential to ensure a balanced diet that includes a variety of nutrients, not just protein.