The emergency room nurse is caring for a family who lost an adolescent in a violent car accident. Which initial nursing action best helps the family’s grieving process?

Choice A reason: Rheumatic fever follows streptococcal infection but typically presents with joint pain, carditis, or rash, not puffy eyes or abnormal urine. Glomerulonephritis better matches the symptoms post-infection, making this incorrect for the suspected condition based on the child’s presentation and history.

Choice B reason: Lipoid nephrosis causes edema and proteinuria but is not typically linked to recent infections or hematuria. Acute glomerulonephritis, often post-streptococcal, explains puffy eyes and abnormal urine, making this less fitting and incorrect for the child’s symptoms following ear infections.

Choice C reason: Urinary tract infections cause dysuria or frequency, not puffy eyes or hematuria post-infection. Acute glomerulonephritis aligns with the history of ear infections (possible streptococcal link) and symptoms, making this incorrect for the suspected condition in this child with these signs.

Choice D reason: Acute glomerulonephritis, often post-streptococcal (e.g., after ear infections), causes hematuria (“funny” urine), periorbital edema (puffy eyes), and headache. This aligns with pediatric nephrology evidence, making it the correct condition the nurse suspects based on the child’s symptoms and medical history.

Choice A reason: Reassuring the sister while attending to the child and involving her in interventions reduces her anxiety, stabilizing the 5-year-old’s emotional state. This aligns with pediatric emergency care principles, making it the best initial action to manage the escalating anxiety in the emergency room.

Choice B reason: Asking the sister to leave may increase her distress and isolate the child, worsening his anxiety. Reassuring and involving her is more supportive, making this counterproductive and incorrect compared to the nurse’s role in calming both the caregiver and child effectively.

Choice C reason: Reassuring the child about his sister’s nerves doesn’t address her anxiety, which is escalating his distress. Involving the sister in care reduces both anxieties, making this insufficient and incorrect compared to the nurse’s priority of stabilizing the emotional environment in the ER.

Choice D reason: Asking the sister to calm down may heighten her distress, as she’s already hysterical, and doesn’t offer support. Reassuring and involving her helps both, making this ineffective and incorrect compared to the nurse’s action to reduce anxiety for the child and caregiver.