A 9-year-old often comes to the school nurse complaining of stomach pains. The teacher says that the child has lately been somewhat aggressive and stubborn in the classroom. What should the school nurse recognize as the possible trigger for these behaviors?

The correct answer is choice A. Wearing cotton underpants.

Choice A rationale:

Wearing cotton underpants is the recommended option to prevent urinary tract infections (UTIs) in young girls. Cotton underpants allow better air circulation, which helps to keep the perineal area dry. This reduces the growth of bacteria and prevents moisture buildup, which are crucial in preventing UTIs. Synthetic fabrics can trap moisture and create a conducive environment for bacterial growth, increasing the risk of UTIs.

Choice B rationale:

Limiting bathing as much as possible is not an appropriate recommendation for preventing UTIs. Hygiene is essential to prevent UTIs, and regular bathing is part of maintaining cleanliness. Overly limiting bathing can lead to poor hygiene practices and may not significantly prevent UTIs, as they are often caused by factors beyond bathing frequency.

Choice C rationale:

Increasing fluids and decreasing salt intake can be beneficial for overall health but may not directly prevent UTIs. While staying hydrated is important for maintaining urinary health, simply increasing fluids and reducing salt intake might not be sufficient to prevent UTIs. Hygiene practices and proper perineal care play a more significant role in preventing UTIs.

Choice D rationale:

Cleansing the perineum with water after voiding is a good hygiene practice, but it alone may not be enough to prevent UTIs. While maintaining cleanliness is crucial, using water to cleanse the perineum after voiding should be combined with other practices, such as wearing cotton underpants and proper wiping techniques, to effectively prevent UTIs.

The correct answer is Choice B: Dry skin.

Choice A rationale:

Diarrhea is not a common clinical manifestation of juvenile hypothyroidism. Hypothyroidism is characterized by an underactive thyroid gland, leading to a decrease in metabolic activity. Symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, constipation, and dry skin, but not diarrhea.

Choice B rationale:

Dry skin is a common clinical manifestation of juvenile hypothyroidism. The decreased thyroid function results in a slower metabolic rate, which can lead to dry and coarse skin due to reduced oil production. This symptom is often seen in hypothyroid patients.

Choice C rationale:

Insomnia is not a common clinical manifestation of juvenile hypothyroidism. Hypothyroidism usually leads to fatigue and excessive sleepiness rather than insomnia.

Choice D rationale:

Accelerated growth is not a common clinical manifestation of juvenile hypothyroidism. In fact, the opposite is true. Hypothyroidism in children can lead to growth retardation due to the decreased metabolic rate and altered hormonal balance.