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.)

Rationale for Correct Choices:

• Seizures: The adolescent’s fever, headache, photophobia, and neck stiffness (resistance to flexion) are consistent with signs of meningitis, which can lead to seizures, especially in the setting of increased intracranial pressure. Seizures are a known complication of untreated or severe meningitis.
• Signs of meningeal irritation: The adolescent demonstrates classic signs of meningeal irritation, such as photophobia, severe headache, and neck stiffness, which suggest inflammation of the meninges. This is a key indicator of potential meningitis and the associated risk of seizures.

Rationale for Incorrect Choices:

• Lyme disease: While Lyme disease can cause neurological symptoms, including headache and fever, the absence of a characteristic erythema migrans rash or recent tick exposure makes it less likely.
• Constipation: Constipation is not a likely complication given the adolescent's current symptoms, which are focused on fever, headache, and neurological signs. It does not explain the risk for seizures.
• Mononucleosis: Although mononucleosis can cause fever and malaise, it typically does not present with neck stiffness, photophobia, or the acute onset of severe headache that is suggestive of meningitis. The symptoms in this case are more concerning for meningitis.
• Pneumonia: Pneumonia is unlikely given the absence of respiratory findings such as cough or difficulty breathing. The symptoms are more consistent with a central nervous system infection, like meningitis, than a respiratory infection.
• Fever: While fever is present in meningitis, it alone does not indicate the risk for seizures. It is the combination of fever, headache, photophobia, and meningeal signs that increases the risk for complications like seizures.
• Inability to eat and drink: The inability to eat and drink is likely a result of nausea and vomiting, which is common in many illnesses, including meningitis. However, it is not a direct indicator of the risk for seizures, which is more strongly linked to meningeal irritation.
• Respiratory findings: There are no significant respiratory symptoms, such as difficulty breathing or abnormal lung sounds, making respiratory findings irrelevant in this case. The adolescent’s symptoms are primarily neurological.

A. Give the infant a bottle immediately before the infant's bedtime: Feeding the infant immediately before bedtime can increase the risk of reflux as lying down soon after feeding can worsen gastroesophageal reflux. The infant should be kept upright after feeding.
B. Keep the infant at a 30-degree angle for 1 hour following each feeding: Keeping the infant upright at a 30-degree angle for about 30 to 60 minutes after feeding can help prevent the contents of the stomach from refluxing into the esophagus.
C. Limit the infant's formula feedings to every 6 hr: Infants with gastroesophageal reflux typically need more frequent feedings, not less. Limiting feedings to every 6 hours is not appropriate for a 2-month-old infant. Frequent, smaller feedings may help manage reflux.
D. Change the infant's formula to a soy-based formula: Switching to a soy-based formula is not a standard treatment for gastroesophageal reflux unless there is a specific allergy or intolerance to cow's milk protein. This should only be done if directed by the healthcare provider.