An 18-month-old girl is diagnosed as having atopic dermatitis.
When interviewing her parents, they describe the following care measures. Which one would lead you to think more health teaching is needed?

Choice A rationale

Adjusting the intravenous fluid infusion rate is not the immediate priority after an amniotomy. This action is not directly related to the most critical and immediate potential complication of this procedure, which is a change in the fetal heart rate. The primary concern is the potential for umbilical cord prolapse, which can lead to fetal hypoxia.

Choice B rationale

Providing a clean gown and linens is important for client comfort and hygiene, but it is not the immediate priority. The nurse must first ensure the safety of the fetus by assessing for complications that can arise from the procedure, such as umbilical cord compression or prolapse, which can lead to fetal distress and requires immediate intervention.

Choice C rationale

The immediate priority after an amniotomy is to assess the fetal heart rate. The sudden release of amniotic fluid can cause the umbilical cord to prolapse and become compressed, leading to a rapid decrease in blood flow and oxygen to the fetus. This compression results in fetal bradycardia, a critical finding requiring immediate intervention to prevent fetal hypoxia and death.

Choice D rationale

Assisting the client to wash the perineum is a hygiene measure that can be performed after the immediate safety of the fetus has been established. It is not the priority action. The nurse must first rule out any life-threatening complications to the fetus, such as cord prolapse, which is a significant risk following the rupture of membranes.

Choice A rationale

Racemic epinephrine nebulizer therapy is a highly effective measure for bronchodilation in a child with croup. This alpha-adrenergic agonist works by stimulating receptors in the smooth muscle of the airway. This stimulation leads to vasoconstriction, reducing the mucosal edema and swelling of the vocal cords and trachea that are characteristic of croup. The rapid reduction in upper airway inflammation and swelling directly alleviates stridor and respiratory distress, improving airflow and oxygenation.

Choice B rationale

Teaching a child to take long, slow breaths is generally a technique used for anxiety or to prevent hyperventilation. However, in a child with croup, the upper airway obstruction makes deep breathing difficult and may increase their distress. The effort to take long, slow breaths against a narrowed airway can further exacerbate the child's respiratory effort and may not provide any significant relief from the underlying swelling.

Choice C rationale

Administering an oral analgesic would be ineffective for aiding bronchodilation in a child with croup. The primary issue in croup is upper airway inflammation and edema, not pain. Analgesics, such as acetaminophen or ibuprofen, primarily work to reduce fever and discomfort. They have no direct pharmacological effect on the smooth muscles of the bronchi or on the mucosal swelling that is causing the respiratory distress.

Choice D rationale

Urging a child to continue to take oral fluids is important for hydration, but it does not directly aid in bronchodilation. In a child with significant respiratory distress from croup, encouraging oral fluids may actually pose a risk for aspiration due to their difficulty breathing and potential fatigue. While hydration is a supportive measure, it does not address the underlying pathology of airway swelling and is not a primary intervention for bronchodilation.