A nurse is assisting with the care of a toddler who has a septal defect and is scheduled for a cardiac catheterization. Which of the following actions should the nurse take?

A. Position the child sitting with their buttocks at the edge of the table: This position is not appropriate for bone marrow aspiration. It does not provide adequate access to the iliac crest, which is the common site for bone marrow collection in children.
B. Position the child side-lying to expose the vertebrae: The vertebrae are not typically used for bone marrow aspiration. The iliac crest (the top of the hip bone) is the preferred site, and side-lying does not expose this area appropriately for the procedure.
C. Place the child supine with legs flexed outward into a frog-like position: This position is commonly used for procedures such as abdominal or pelvic examinations but does not provide the best access for bone marrow aspiration from the iliac crest.
D. Place the child in prone position to expose the posterior iliac crest: The prone position with the back exposed allows the posterior iliac crest to be properly accessed for bone marrow aspiration. This is the correct position for the procedure in children.

Rationale for Correct Choices:

• Blood pressure: The adolescent's blood pressure has decreased significantly from 116/60 mm Hg to 88/50 mm Hg, indicating hypotension. This is a priority, as low blood pressure can lead to poor perfusion of vital organs and can worsen the overall condition. Immediate action, such as fluid resuscitation, is necessary.
• Temperature: The adolescent has a persistent high fever (39°C or 102.2°F), which needs to be managed to prevent complications such as febrile seizures or increased intracranial pressure, especially given the suspected meningitis. Fever management will help improve comfort and reduce metabolic demand on the body.

Rationale for Incorrect Choices:

• Nausea: While nausea is an uncomfortable symptom, it is not as urgent as hypotension. Managing blood pressure and stabilizing the adolescent's circulation takes priority before addressing nausea.
• Level of consciousness: The adolescent is lethargic but responsive to verbal stimuli. While their level of consciousness is important to monitor, it is primarily related to the underlying infection (likely meningitis). Stabilizing blood pressure and fever should be prioritized.
• Abdominal findings: The adolescent's abdominal findings (soft, flat abdomen with active bowel sounds) are not immediately concerning. The priority is managing the acute symptoms related to suspected meningitis and hypotension, rather than abdominal issues.