A nurse is assisting with the development of an education program about child maltreatment. Which of the following findings should the nurse include in the program as a possible indication of sexual abuse?

Rationale for Correct Choices:

• Seizures: The adolescent’s fever, headache, photophobia, and neck stiffness (resistance to flexion) are consistent with signs of meningitis, which can lead to seizures, especially in the setting of increased intracranial pressure. Seizures are a known complication of untreated or severe meningitis.
• Signs of meningeal irritation: The adolescent demonstrates classic signs of meningeal irritation, such as photophobia, severe headache, and neck stiffness, which suggest inflammation of the meninges. This is a key indicator of potential meningitis and the associated risk of seizures.

Rationale for Incorrect Choices:

• Lyme disease: While Lyme disease can cause neurological symptoms, including headache and fever, the absence of a characteristic erythema migrans rash or recent tick exposure makes it less likely.
• Constipation: Constipation is not a likely complication given the adolescent's current symptoms, which are focused on fever, headache, and neurological signs. It does not explain the risk for seizures.
• Mononucleosis: Although mononucleosis can cause fever and malaise, it typically does not present with neck stiffness, photophobia, or the acute onset of severe headache that is suggestive of meningitis. The symptoms in this case are more concerning for meningitis.
• Pneumonia: Pneumonia is unlikely given the absence of respiratory findings such as cough or difficulty breathing. The symptoms are more consistent with a central nervous system infection, like meningitis, than a respiratory infection.
• Fever: While fever is present in meningitis, it alone does not indicate the risk for seizures. It is the combination of fever, headache, photophobia, and meningeal signs that increases the risk for complications like seizures.
• Inability to eat and drink: The inability to eat and drink is likely a result of nausea and vomiting, which is common in many illnesses, including meningitis. However, it is not a direct indicator of the risk for seizures, which is more strongly linked to meningeal irritation.
• Respiratory findings: There are no significant respiratory symptoms, such as difficulty breathing or abnormal lung sounds, making respiratory findings irrelevant in this case. The adolescent’s symptoms are primarily neurological.

A. Edema: Edema can occur with heart failure, but it is not specifically an indication of digoxin toxicity. Digoxin helps improve heart function and reduce edema, so it is not a direct sign of toxicity.
B. Jaundice: Jaundice may indicate liver dysfunction, but it is not a common sign of digoxin toxicity. Liver function issues can arise from various causes, but jaundice is not typically associated with digoxin toxicity.
C. Purulent sputum: Purulent sputum suggests an infection, such as pneumonia, and is not related to digoxin toxicity. This symptom requires further evaluation for respiratory infections, not digoxin-related issues.
D. Bradycardia: Bradycardia (a slow heart rate) is a classic sign of digoxin toxicity. Digoxin can slow the heart rate by affecting the electrical conduction system of the heart, and bradycardia is a key indicator of overdose or toxicity in infants and children taking this medication.