To enhance the effectiveness of the pharmacological pain intervention administered to a 4-year old child with an injured knee, the nurse plans to add a nonpharmacological intervention. Which of the following actions would be appropriate for the nurse to perform? (select all that apply)

A. An abnormal finding-indicates the need for developmental assessment.

This is not accurate. The closure of the anterior fontanel within the expected age range does not indicate an abnormal finding or the need for additional developmental assessment.

B. A normal finding.

This is the correct interpretation. The anterior fontanel normally closes between 12 to 18 months, and closure by 19 months is within the expected developmental range.

C. An abnormal finding-indicates the need for immediate referral to a practitioner.

This is not necessary based on the information provided. The closure of the anterior fontanel within the expected timeframe is a normal finding.

D. A questionable finding-the infant should be rechecked in 1 month.

There's no need for rechecking in 1 month. The closure of the anterior fontanel at 19 months is considered normal.

A. Parents are shocked when their child is diagnosed with a malignant bone tumor. The orthopedic surgeon discusses the options of limb amputation and a limb-salvage procedure. The parents are asked to consider each option.

This situation involves a difficult medical decision, but it does not describe a conflict or ethical dilemma that necessitates immediate involvement of the ethics committee. The parents are being informed about treatment options, and their input is sought in making a decision for their child's care.

B. The physician recommends that a young child be taken off the ventilator. The parents, who are divorced and have joint custody of the child, have differing views about whether to discontinue the ventilator.

This scenario presents a clear ethical dilemma involving the withdrawal of life-sustaining treatment. The differing views of the divorced parents with joint custody may require the involvement of the hospital ethics committee to provide guidance and facilitate resolution.

C. A child in end-stage renal failure is placed on the renal transplant list. The parents are asked to sign permission for surgery after a cadaver kidney is located. One parent is out of town and gives telephone consent.

While organ transplantation involves ethical considerations, the described situation does not present an immediate conflict or dilemma that requires the ethics committee's urgent involvement. The scenario seems to involve a common process of obtaining consent for surgery.

D. After initial therapies have failed, a child with leukemia is evaluated for a new cancer protocol. The child, age 8 years, gives assent for the new treatment, and his parents give their consent.

This scenario involves a child participating in the decision-making process through assent, and the parents providing consent. While significant, it does not describe a conflict or ethical dilemma that requires immediate ethics committee involvement. The situation seems to involve standard procedures for obtaining informed assent and consent for medical treatment.