The practical nurse (PN) is caring for a toddler who is hospitalized for pneumonia.
Which stressor is most significant during hospitalization for this age group?

Choice A rationale

Promoting range-of-motion is typically achieved through exercises and movement. Dynamic splinting aims to maintain a specific joint position rather than actively increasing range of motion, which might be counterproductive to hip stability in developmental dysplasia.

Choice B rationale

Increasing extension would involve straightening the hip joint. In developmental dysplasia of the hip, the goal of treatment is to maintain the femoral head within the acetabulum, which often requires a flexed and abducted position, not extension.

Choice C rationale

Maintaining abduction is the primary purpose of dynamic splinting in developmental dysplasia of the hip. Abduction helps to seat the femoral head deeply into the acetabulum, promoting proper hip development and stability by stimulating acetabular ossification.

Choice D rationale

Providing immobilization implies completely restricting movement. Dynamic splinting, like the Pavlik harness, allows some movement while maintaining the abduction, flexion, and external rotation necessary for proper hip development. Full immobilization is typically not the goal for developmental dysplasia.

Choice A rationale

Deep tendon reflexes are neurological assessments primarily used to evaluate neuromuscular excitability, particularly in conditions like preeclampsia where magnesium sulfate is administered. They are not indicated for managing fetal heart rate decelerations or chorioamnionitis, as these conditions do not directly impact spinal reflex arcs or necessitate this specific neurological monitoring. Normal reflexes range from 1+ to 2+.

Choice B rationale

Late decelerations, occurring after the peak of a contraction, indicate uteroplacental insufficiency, meaning reduced blood flow and oxygen to the fetus. A left side-lying position alleviates compression of the vena cava and aorta by the gravid uterus, thereby increasing venous return to the heart and improving uterine perfusion and oxygenation to the fetus, which is a crucial intervention.

Choice C rationale

Insertion of an indwelling urinary catheter to monitor hourly output is primarily indicated for assessing renal perfusion and fluid balance, particularly in critically ill clients or those at risk for fluid volume alterations, such as severe preeclampsia. It does not directly address or correct the underlying physiological cause of late fetal heart rate decelerations. Normal urine output is typically greater than 30 mL/hour.

Choice D rationale

Collecting a urine specimen for electrolytes and protein is a diagnostic measure for evaluating renal function, hydration status, and potential complications like preeclampsia, which presents with proteinuria. While important for overall assessment, it does not provide an immediate physiological intervention to improve uteroplacental perfusion and resolve acute fetal distress manifested by late decelerations.