The nurse is caring for a 14-year-old adolescent who is prescribed levothyroxine for hypothyroidism. The nurse should instruct the client and caregivers to monitor for which of the following potential adverse effects of this medication?

Choice A reason: Taking an axillary temperature is standard but not specific to myelomeningocele care. While monitoring for infection is important, it does not address the unique need to protect the exposed spinal sac, which is critical to prevent infection and trauma in this condition.

Choice B reason: Performing range of motion on the hips risks damaging the myelomeningocele sac, which contains nerve roots. Movement could cause sac rupture or neurological worsening, as the exposed neural tissue is highly vulnerable, making this action contraindicated in this fragile condition.

Choice C reason: Side-lying positioning may be used but is not the most critical action. It helps avoid pressure on the sac, but maintaining a dry, sterile dressing is paramount to prevent infection, a life-threatening complication in myelomeningocele due to exposed neural tissue.

Choice D reason: Maintaining a dry dressing over the myelomeningocele sac prevents infection and trauma to exposed neural tissue. A sterile, moist environment protects the sac until surgical repair, reducing the risk of meningitis or further neurological damage, indicating effective understanding of this condition’s care.

Choice A reason: Droplet precautions are unnecessary for impetigo, a bacterial skin infection spread by direct contact, not respiratory droplets. Home isolation focuses on contact precautions, like avoiding shared items, to prevent spread, making droplet precautions irrelevant for managing impetigo transmission.

Choice B reason: Immunization is not available for impetigo, caused by Staphylococcus or Streptococcus bacteria. Unlike viral diseases, impetigo is treated with antibiotics, not prevented by vaccines. Household contacts require hygiene measures, not immunization, to avoid bacterial spread through direct contact.

Choice C reason: Chlorine baths are not a standard treatment for impetigo. While antiseptic washes may reduce bacterial load, chlorine can irritate skin, worsening lesions. Antibiotic therapy, topical or oral, is the primary treatment to eradicate the bacterial infection causing impetigo.

Choice D reason: Washing clothing in hot water kills bacteria causing impetigo, like Staphylococcus aureus, preventing reinfection or spread to others. Hot water and detergent effectively decontaminate fabrics, reducing bacterial load on items in contact with lesions, a critical measure for infection control.