The toddler is at risk for developing hearing loss as evidenced by the toddler's bone biopsy results.

Choice A rationale

Giving the infant liquids using a small spoon with a long handle is an incorrect action. Postoperative care for a cleft palate repair focuses on protecting the surgical site to prevent dehiscence. Using a spoon, especially a hard one, can cause trauma to the fragile sutures and is contraindicated. The child should be fed using a specific device, like a syringe with tubing or a special bottle, to bypass the repair site.

Choice B rationale

Applying elbow restraints to the infant is a critical intervention following a cleft palate repair. These restraints prevent the infant from flexing their elbows, which in turn stops them from bringing their hands to their mouth. This action is crucial because touching or rubbing the surgical site can lead to disruption of the sutures, causing dehiscence and negatively impacting the healing process.

Choice C rationale

Gently checking the infant's suture line using a padded tongue depressor is a dangerous and inappropriate action. Any object placed in the infant's mouth, including a tongue depressor, can cause significant trauma to the delicate surgical site. Direct visualization is sufficient for assessment, and instrumentation should be avoided to prevent damage to the newly repaired palate.

Choice D rationale

Placing the infant in a supine position immediately after a cleft palate repair is an inappropriate action. The supine position increases the risk of aspiration, especially if there is bleeding or secretions. The infant should be placed on their side or abdomen to facilitate drainage of oral secretions and blood away from the airway, which helps maintain a clear airway and reduces the risk of respiratory distress.

Choice A rationale

Urticaria, a form of rash or hives, is an acute hypersensitivity reaction to cefazolin, a cephalosporin antibiotic. This reaction is mediated by IgE antibodies and can indicate the onset of a severe allergic response, which can escalate to life-threatening anaphylaxis. Instructing the adolescent to monitor for and report urticaria is critical for patient safety and preventing a more severe allergic event.

Choice B rationale

Dry mouth is not a common adverse effect associated with cefazolin. Cephalosporin antibiotics typically affect the gastrointestinal system by altering the gut microbiota, which can lead to diarrhea. Dry mouth is more often linked to medications with anticholinergic properties or dehydration, not to this class of antibiotics.

Choice C rationale

Constipation is not a recognized side effect of cefazolin. While cephalosporin antibiotics can cause gastrointestinal disturbances, the most common is diarrhea. Constipation is generally not a significant adverse event and would not be a priority instruction for an adolescent taking this medication.

Choice D rationale

Back pain is not an adverse effect of cefazolin. This symptom is not typically associated with cephalosporin antibiotics. Back pain is more likely to be related to musculoskeletal issues, injury, or other underlying medical conditions and is not a priority adverse effect to monitor for with this medication.