The nurse is planning care for a child in the acute phase of Kawasaki disease.
Which intervention is priority?

Choice A rationale

The sweat chloride test is the gold standard diagnostic test for cystic fibrosis (CF). CF is caused by a mutation in the CFTR gene, which impairs chloride ion transport across epithelial cells. This defect leads to abnormally high chloride concentration in sweat, typically >60 mEq/L in children, which provides biochemical confirmation of the disease.

Choice B rationale

Pulmonary function tests (PFTs) measure lung volumes and airflow, typically revealing an obstructive pattern in CF due to chronic infection and inflammation. While they monitor disease progression and severity, PFTs are not diagnostic for the underlying genetic disorder that defines cystic fibrosis.

Choice C rationale

A Chest X-ray (CXR) may show characteristic findings of chronic lung disease in CF, such as bronchiectasis, hyperinflation, or atelectasis, reflecting the disease's pulmonary complications. However, the CXR is an imaging tool for assessing lung structure, not a diagnostic test for the systemic genetic condition itself.

Choice D rationale

Sputum cultures are used to identify the specific bacterial pathogens, such as Pseudomonas aeruginosa or Staphylococcus aureus, colonizing the airways of CF patients. While essential for guiding antibiotic therapy, a sputum culture only detects secondary infection and does not confirm the diagnosis of cystic fibrosis.

Choice A rationale

During a tonic-clonic seizure, loss of consciousness and uncontrolled muscle movements carry a high risk of aspiration if the child vomits or has excessive oral secretions. Turning the child to the side (recovery position) allows gravity to drain secretions and prevents the tongue from obstructing the posterior pharynx, which is the most critical immediate safety intervention.

Choice B rationale

While benzodiazepines (like rectal or intranasal diazepam or midazolam) are used to stop seizures, this is done via a non-oral route as the child is typically unconscious and unable to safely swallow during a seizure, posing a severe aspiration risk. Oral administration is contraindicated during the acute seizure event itself.

Choice C rationale

Inserting a tongue blade or any object into the mouth during a seizure is strictly contraindicated. The child's jaw may clamp down forcefully, causing injury to the child's teeth, gums, or jaw, or causing the object to break and obstruct the airway, leading to far more harm than benefit.

Choice D rationale

Restraining the child during a seizure is inappropriate and dangerous. The forceful muscle contractions can cause injury (fractures or dislocations) if movement is restricted against the convulsive forces. The nurse's role is to clear the area and protect the head and limbs from striking hard objects.