A nurse is caring for a child who is 2 hours postoperative following a tonsillectomy. Which of the following fluid items should the nurse offer the child at this time?

Choice A: Loosening restrictive clothing is not the priority action, but rather a secondary action for a child who is having a tonic-clonic seizure and vomiting. A tonic-clonic seizure is a type of seizure that involves the stiffening of muscles (tonic phase) followed by jerking movements (clonic phase). Loosening restrictive clothing can prevent injury or discomfort to the child during or after the seizure.

Choice B: Placing a pillow under the child's head is not the priority action, but rather an inappropriate action for a child who is having a tonic-clonic seizure and vomiting. A pillow under the head can obstruct the airway or cause aspiration of vomitus into the lungs. The nurse should remove any pillows or objects from around the head and neck area and support the head with their hands or on a flat surface.

Choice C: Clearing the area of hazards is not the priority action, but rather a secondary action for a child who is having a tonic-clonic seizure and vomiting. Clearing the area of hazards can prevent injury or harm to the child or others during or after the seizure. The nurse should remove any sharp, hard, or flammable objects from near or under the child and move any furniture or equipment away.

Choice D: Positioning the child side-lying is the priority action for a child who is having a tonic-clonic seizure and vomiting, as it can protect the airway and prevent aspiration of vomitus into the lungs. Aspiration can cause pneumonia, which is an infection of the lungs that can cause fever, cough, difficulty breathing, or death. The nurse should turn the child's head to one side and place them on their side with their knees bent and one arm under their head. The nurse should also suction any vomitus from their mouth and nose if needed.

Choice A reason: This choice is incorrect because tying colorful latex balloons to the side of
the crib may pose a risk of choking or suffocation for the infant who is in a cast for DDH. Latex balloons are made of rubber that can break easily and form small pieces that can block the airway or lungs if swallowed or inhaled by
the infant. Therefore, avoiding latex products such as balloons, gloves, or bandages is important to prevent accidents or injuries.

Choice B reason: This choice is incorrect because following the doctor's instructions regarding activities and treatment plans is not a specific strategy to promote the infant's growth and development. Following
the doctor's instructions regarding activities and treatment plans is a general responsibility of the nurse that applies to any client who has any condition or procedure. It may help to ensure the safety and effectiveness of the care, but it does not address the developmental needs of the infant who is in a cast for DDH.

Choice C reason: This choice is correct because providing a small electronic toy is a specific strategy to promote
the infant's growth and development. Providing a small electronic toy can help stimulate the infant's senses, cognition, and motor skills by offering visual, auditory, or tactile feedback. It may also help to reduce boredom, frustration, or depression by providing entertainment, diversion, or comfort. Therefore, providing a small electronic toy can help to enhance the developmental outcomes of the infant who is in a cast for DDH.

Choice D reason: This choice is incorrect because changing the infant's diaper as soon as soiling occurs is not a specific strategy to promote the infant's growth and development. Changing the infant's diaper as soon as soiling occurs is a general hygiene measure that applies to any infant who wears a diaper. It may help to prevent skin irritation, infection, or odor by keeping the diaper area clean and dry, but it does not address the developmental needs of the infant who is in a cast for DDH.