A 4-year-old girl returns to the pediatrician's office for a postoperative visit following hospitalization for minor surgery. When observing the child in the waiting area, which behavior should the nurse consider normal for this age child?

A. Observe the child for blank, sunken eyes.Blank, sunken eyes are not associated with strabismus. These could be signs of other conditions, such as dehydration or severe malnutrition, but they are not relevant for assessing strabismus.

B. Inspect the child for the setting-sun sign.The setting-sun sign is more commonly associated with increased intracranial pressure in infants and is not a relevant observation for detecting strabismus in a 5-year-old child.

C. Have the child identify colored patterns on polychromatic cards.Identifying colored patterns on polychromatic cards is a test for color vision, not for strabismus. Strabismus involves misalignment of the eyes rather than a problem with color perception.

D. Direct the child through the six cardinal positions of gaze.The six cardinal positions of gaze test the alignment and movement of the eyes. The nurse asks the child to follow an object with their eyes as it is moved through these six positions. Any inability of the eyes to maintain proper alignment or any deviation from the expected movement can indicate strabismus. This is an effective and commonly used method to screen for strabismus in children.

C. Manual resuscitation bag: In the case of a child with inspiratory stridor and retractions, there is a concern about airway obstruction. Having a manual resuscitation bag available is crucial to ensure that the child's airway can be effectively managed in case of respiratory distress.

E. An advanced airway kit: If the child's condition worsens and he experiences severe respiratory distress or failure, an advanced airway may be necessary to secure the airway and provide proper oxygenation. Having an advanced airway kit available is important in case intubation becomes necessary.

Incorrect answers:

A. Elbow restraints: Elbow restraints are not typically used during peripheral intravenous line placement. They are used to prevent children from bending their arms excessively after specific surgeries or procedures.

B. The child's favorite toy: While having a favorite toy might help distract the child and reduce anxiety, it is not a critical item needed for the placement of a peripheral intravenous line.

D. A dose of subcutaneous epinephrine: Subcutaneous epinephrine is not used for the placement of an intravenous line. It is typically used to treat severe allergic reactions (anaphylaxis).

F. Nebulized albuterol: Nebulized albuterol is a medication used to treat bronchospasm in conditions such as asthma. While the child is experiencing respiratory distress, the priority is to secure the airway and provide oxygenation, which may involve using a manual resuscitation bag and an advanced airway kit.