Which vital sign change is most concerning in a child with respiratory distress?

Choice A rationale

Restricting fluids is generally contraindicated in meningitis unless there is documented syndrome of inappropriate antidiuretic hormone (SIADH) or severe, life-threatening cerebral edema. Maintaining adequate hydration is crucial to prevent dehydration and support systemic circulation, especially since fever can increase fluid loss.

Choice B rationale

Monitoring for signs of increased intracranial pressure (ICP) is paramount because meningeal inflammation can lead to cerebral edema and impaired CSF reabsorption. Signs like changes in level of consciousness, bradycardia, and hypertension (Cushing's triad) require immediate intervention to prevent brain herniation.

Choice C rationale

Administering acetaminophen (or ibuprofen) is appropriate for controlling the systemic symptoms of fever (pyrexia) and managing headache/body pain associated with meningeal irritation. Effective fever control reduces metabolic demands and can decrease the risk of febrile seizures.

Choice D rationale

Administering IV antibiotics immediately is the standard for bacterial meningitis to prevent morbidity and mortality, but viral meningitis is typically self-limiting and managed with supportive care; thus, empirical antibiotics are not indicated if the viral etiology is confirmed or highly suspected.

Choice E rationale

Encouraging rest and hydration is the cornerstone of supportive care for viral meningitis. Rest reduces cerebral metabolic demand and prevents overexertion, while hydration helps combat fluid losses from fever and vomiting and supports overall recovery.

Choice F rationale

Providing a quiet, dimly lit environment helps reduce noxious stimuli that can exacerbate common symptoms like headache and photophobia (light sensitivity), which are caused by meningeal inflammation and irritation of cranial nerves, thus promoting comfort and rest.

Choice A rationale

Furosemide is a loop diuretic that promotes the excretion of sodium and water, reducing fluid overload and pulmonary congestion associated with congestive heart failure. A decreased urine output of 0.5 mL/kg/hr is a sign of worsening status, as the target output for adequate diuresis is generally 1-3 mL/kg/hr for children.

Choice B rationale

Furosemide therapy is intended to reduce fluid volume, which should result in weight loss. An increase in weight of 1.5 kg indicates fluid retention and ineffective or inadequate diuretic therapy, signaling a deterioration or lack of improvement in the child's congestive heart failure.

Choice C rationale

A decrease in respiratory rate from 50 to 32 breaths per minute indicates a reduction in tachypnea. Tachypnea in congestive heart failure is caused by fluid backup into the lungs (pulmonary congestion), which decreases lung compliance. The reduction in rate suggests that the diuretic has successfully lowered the pulmonary fluid volume, improving respiratory function.

Choice D rationale

An increase in heart rate to 160 bpm (tachycardia) in a school-aged child (normal resting heart rate ≈ 70-110 bpm) is a compensatory mechanism for decreased stroke volume, often seen in worsening heart failure or dehydration. This finding indicates deterioration or a negative effect of the diuretic, such as volume depletion.