Exhibits

A nurse is collecting data from an adolescent who has a new diagnosis of infectious mononucleosis. Which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

A. Hopscotch: Hopscotch typically requires the ability to hop on one foot and follow a structured set of rules, which may be too advanced for a 2-year-old. Toddlers are still developing coordination and motor skills, so activities like hopscotch are not age-appropriate.
B. Beginner sports: While toddlers can start developing coordination, organized sports (even beginner ones) usually require more advanced skills like following directions and teamwork, which may not be suitable for a 2-year-old.
C. Finger paints: Finger painting is an ideal activity for a 2-year-old. It encourages creativity, helps with fine motor skills, and is enjoyable for toddlers as they explore textures and colors. It is a developmentally appropriate form of play.
D. 30-piece puzzle: A 30-piece puzzle may be too complex for a 2-year-old. Toddlers typically enjoy simpler puzzles with larger pieces, which are easier for their developing fine motor skills and cognitive abilities. A simpler puzzle would be more appropriate.

Rationale for Correct Choices:

• Fontanel finding: The sunken fontanel indicates signs of dehydration, which is the primary concern for this infant. Dehydration can lead to severe complications and should be addressed first through appropriate fluid resuscitation (IV fluids) to prevent further deterioration.
• Temperature: The infant has a fever of 38.4°C (101.1°F), which needs to be managed with acetaminophen as prescribed. While dehydration is the priority, the temperature should also be controlled to prevent worsening of the infant's condition and to make the child more comfortable.

Rationale for Incorrect Choices:

• Diaper area: While the excoriated diaper area is concerning, it is not the most urgent issue compared to dehydration, which can quickly worsen. Dehydration and fever management should be prioritized before addressing skin irritation.
• Stool culture results: The positive stool culture for Shigella is important for determining the infection, but addressing the infant's hydration status and fever is more urgent to stabilize the child. The results will guide further treatment but do not need immediate intervention over dehydration.
• Appetite history: While the infant's poor feeding history is significant, addressing dehydration and fever management should take precedence to stabilize the infant before evaluating feeding patterns in more detail.
• Activity tolerance finding: The infant’s fatigue is likely due to dehydration and fever. Stabilizing hydration and controlling the fever will improve the infant’s activity tolerance, making this secondary to the more urgent issues.