Exhibits

A nurse is caring for a school-age child who is dehydrated. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Rationale for Correct Choices

• Give iron with vitamin C to increase absorption: Vitamin C enhances the solubility and bioavailability of iron, which is especially important for a child on a vegetarian diet where non-heme iron predominates. Taking iron with citrus juice or ascorbic acid reduces the risk of poor absorption and supports correction of anemia.

• Give iron through a straw to prevent staining of teeth: Liquid iron supplements can cause temporary discoloration of tooth enamel. Using a straw minimizes direct contact of iron with the teeth, helping to preserve dental appearance while ensuring the child still receives the full dose.

• Increase intake of iron-rich foods such as beans, leafy greens, and fortified cereals: A vegetarian child should be encouraged to consume a variety of non-heme iron foods. Combining these with vitamin C sources improves absorption and supports bone marrow production of healthy red blood cells.

Rationale for Incorrect Choices

• Give iron with milk to reduce stomach upset: Milk contains calcium and casein, both of which inhibit iron absorption, reducing the effectiveness of therapy.

• Administer iron on an empty stomach with no fluids: Iron is best absorbed on an empty stomach, but giving it without fluids increases gastric irritation and may cause poor adherence in children.

• Encourage brushing with baking soda after iron administration: Baking soda is abrasive and not recommended for children, as it may damage developing enamel while not significantly reducing iron staining.

• Mix iron with milk to reduce metallic taste: Mixing with milk impairs absorption, worsening anemia, and undermines the therapeutic purpose of supplementation.

• Restrict protein sources to avoid overworking bone marrow: Protein is essential for hemoglobin synthesis and red blood cell production; restricting it would worsen the child’s anemic state.

• Reduce iron-containing foods until medication is completed: Limiting dietary iron would prevent recovery from anemia and contradicts the goal of maximizing iron intake during supplementation.

Rationale for correct choices:

• Seizures: Clients with meningitis are at risk for seizures due to meningeal irritation, high fever, and increased intracranial pressure. Neurological complications arise as the infection spreads within the central nervous system, disrupting electrical activity in the brain.

• Level of consciousness: The adolescent is lethargic, drowsy, and irritable when aroused, which reflects altered neurological status. This finding indicates cerebral involvement, which increases the likelihood of seizure activity as the illness progresses.

Rationale for incorrect choices:

• Lyme disease: This condition is caused by tick bites and typically presents with erythema migrans rash, arthralgia, and fatigue, not acute fever, photophobia, or purpuric rash as seen here.

• Pneumonia: Respiratory involvement would present with abnormal breath sounds, cough, or hypoxemia, but this client has clear lung sounds and normal oxygen saturation, making pneumonia unlikely.

• Mononucleosis: This condition usually causes fever, pharyngitis, and lymphadenopathy, but the client’s cervical nodes are normal and their presentation aligns more with meningitis.

• Constipation: Gastrointestinal complications such as constipation are not relevant here since bowel sounds are active, the abdomen is soft, and there are no reports of decreased stooling.

• Abdominal findings: The abdomen is soft, flat, and with normal bowel sounds, which provides no evidence of an abdominal complication linked to meningitis risk.

• Rash: While the purpuric rash supports the diagnosis of meningococcal meningitis, it is not the primary indicator of seizure risk. Neurological status is a stronger predictor of seizure development.

• Cervical lymph nodes: These are normal without edema or tenderness, ruling out lymphatic involvement as a significant concern in this scenario.

• Breath sounds: Breath sounds are clear and equal bilaterally, which excludes a respiratory complication such as pneumonia as the risk factor linked to seizures.