The nurse is completing a health history with the parents of a 6-month-old infant with retinoblastoma. Which symptom should the nurse expect that the parents have observed?

Rationale for correct choices:

• Dexamethasone: This corticosteroid is often used as an adjunct antiemetic in chemotherapy-induced nausea and vomiting, particularly when standard agents like ondansetron are insufficient. It reduces inflammation and influences the chemoreceptor trigger zone to help control symptoms.\

• Begin parenteral nutrition: This supplies nutrients intravenously, bypassing the gastrointestinal tract, which is beneficial when severe vomiting prevents oral or enteral feeding. It ensures adequate caloric and nutrient intake during prolonged intolerance to GI feeding.

Rationale for incorrect choices:

• Phenergan: This antihistamine is effective for motion sickness or mild nausea but is less preferred for severe chemotherapy-induced symptoms in pediatric patients due to sedative and anticholinergic effects. It is not a first-line adjunct to ondansetron in oncology cases.

• Protonix: This proton pump inhibitor reduces gastric acid secretion and is used for GERD or ulcer prevention, not for managing chemotherapy-related nausea and vomiting. Its mechanism does not address the cause of the patient’s symptoms.

• Flagyl: This antimicrobial targets anaerobic bacterial infections and certain protozoa. It has no role in treating chemotherapy-induced nausea or vomiting and would not alleviate the patient’s acute symptoms.

• Initiate enteral feeding: This provides nutrition via a feeding tube if oral intake is insufficient, but persistent severe vomiting makes tolerance poor. Enteral feeding is avoided until nausea is controlled.

• Consult a dietitian: Involving a dietitian can help develop nutritional strategies, but it is an indirect intervention. If weight loss continues with ongoing vomiting, more immediate nutritional support is required.

• Increase caloric intake: Advising increased calories is ineffective if the patient cannot tolerate food due to persistent nausea and vomiting, making parenteral or other specialized interventions more appropriate

Rationale for Correct Choices:

• Cracked lips and strawberry tongue are hallmark mucocutaneous changes in Kawasaki disease, reflecting widespread inflammation of mucous membranes in the acute phase. These are often accompanied by conjunctival injection and rash.

• Aspirin and IV gamma globulin are the mainstay treatments for Kawasaki disease, reducing inflammation and significantly lowering the risk of coronary artery aneurysms when given early in the illness.

Rationale for Incorrect Choices:

• Petechiae and purpura rash are more commonly seen in platelet or clotting disorders such as idiopathic thrombocytopenic purpura or meningococcemia. Kawasaki disease typically presents with diffuse erythematous rash, not pinpoint hemorrhages.

• Polyarthritis may occur in the later stages of Kawasaki disease, but chorea is a neurological manifestation linked to rheumatic fever. This combination does not fit the acute presentation of Kawasaki disease.

• Corticosteroids and antibiotics are not first-line treatments for Kawasaki disease. Antibiotics are ineffective as the cause is not bacterial, and corticosteroids are generally reserved for IVIG-resistant cases.

• ACE inhibitors and NSAIDs are not standard therapy for Kawasaki disease. ACE inhibitors are used in hypertension or heart failure, and NSAIDs are not as effective as high-dose aspirin in reducing the acute inflammatory response in this condition.