A nurse is assisting with the plan of care for10-month-old infant who has HIV. Which of the following interventions should the nurse include in the plan?

A) Request an x-ray of the neck: In cases of suspected epiglottitis, a lateral neck x-ray can help confirm the diagnosis by showing the classic "thumbprint sign," which indicates swelling of the epiglottis. This is a critical diagnostic step, but it should only be performed in a controlled setting where the child’s airway can be monitored closely. The priority is to avoid any procedures that may cause irritation or further compromise the airway.

B) Monitor urine for protein: Monitoring urine for protein is not relevant to the management of epiglottitis. This condition is related to inflammation and obstruction of the upper airway, and the focus should be on respiratory management rather than renal function.

C) Obtain a nasopharyngeal swab: While obtaining a nasopharyngeal swab can help identify the organism causing an infection (often bacterial), it is not the immediate priority in a child with suspected epiglottitis. The child’s airway is the most critical concern, and diagnostic interventions that could potentially cause further distress or obstruction (such as swabbing) should be avoided until airway management is stable.

D) Administer fluconazole: Fluconazole is an antifungal medication, and its use is not appropriate for epiglottitis. Epiglottitis is most often caused by a bacterial infection, particularly Haemophilus influenzae type b (Hib), which requires antibiotic therapy, not antifungals.

A) Tell the client to leave the group if they cannot contribute.
This response is inappropriate as it does not support the client’s participation or create an open, supportive environment. Forcing the client to leave would alienate them and potentially discourage future participation. Group therapy should foster inclusiveness and understanding, not create pressure or exclusion.

B) Allow the client extra time to think of a response.
This is the most appropriate action. Some clients may need additional time to process their thoughts before speaking, especially in a group setting where they may feel anxious or hesitant. Giving the client space and time to formulate a response can encourage participation without forcing them. It allows them to engage at their own pace, promoting comfort and confidence in the group.

C) Appoint the client to lead the discussion.
While giving the client an active role might help them engage, appointing them to lead the discussion could cause undue stress or anxiety, particularly if they are already struggling to contribute. This could overwhelm the client and make them feel more isolated. Instead, a gradual approach to participation is more effective.

D) Ask other group members to limit the number of times they speak.
While this may seem like an effort to allow more time for the silent client, it may not be the best solution. Group therapy is meant to be interactive, and limiting others’ participation may make the group feel less collaborative. It is better to encourage the silent client to speak at their own pace rather than restricting the group’s natural flow of discussion.