A nurse is caring for a child who was admitted with suspected rheumatic fever. The provider prescribes an antistreptolysin O (ASO) titer. The parent asks the nurse about the purpose of the test. Which of the following responses should the nurse make?

Choice A reason: This choice is correct because examining the child's tympanic membrane at the end of the physical examination is the best strategy to avoid upsetting or frightening the child. The tympanic membrane is the thin membrane that separates the outer ear from the middle ear, and it can be examined by using an otoscope, which is a device that has a light and a magnifying lens. Examining the tympanic membrane may be uncomfortable or painful for the child, especially if they have an ear infection or inflammation. Therefore, performing this procedure at the end of the examination can help to minimize the child's distress and resistance.

Choice B reason: This choice is incorrect because examining the child's tympanic membrane before auscultating the chest and abdomen is not a good strategy to avoid upsetting or frightening the child. Auscultating the chest and abdomen is a procedure that involves listening to the sounds of the heart, lungs, and bowel by using a stethoscope, which is a device that has a chest piece and earpieces. Auscultating the chest and abdomen may be soothing or relaxing for the child, as it does not cause any discomfort or pain. Therefore, performing this procedure before examining the tympanic membrane can help to calm and distract the child.

Choice C reason: This choice is incorrect because examining the child's tympanic membrane at the beginning of the physical examination is not a good strategy to avoid upsetting or frightening the child. Examining the tympanic membrane at the beginning of the examination may cause anxiety or fear in the child, which can affect their cooperation and trust for the rest of the examination. Therefore, performing this procedure at the beginning of the examination can increase the child's distress and resistance.

Choice D reason: This choice is incorrect because examining the child's tympanic membrane before examining the
head and neck is not a good strategy to avoid upsetting or frightening the child. Examining the head and neck is a procedure that involves inspecting and palpating the scalp, hair, face, eyes, ears, nose, mouth, throat, lymph nodes, and thyroid gland. Examining the head and neck may be easy or pleasant for the child, as it does not cause any discomfort or pain. Therefore, performing this procedure before examining the tympanic membrane can help to establish rapport and confidence with the child.

Choice A reason: This choice is incorrect because a regular diet, no added salt may not be sufficient to prevent fluid retention and hypertension in a child who has acute glomerulonephritis. Acute glomerulonephritis is an inflammation of the glomeruli, which are the tiny blood vessels that filter blood in the kidneys. It may cause symptoms such as hematuria, proteinuria, oliguria, edema, or hypertension. Therefore, avoiding salt alone may not reduce sodium and water intake and excretion.

Choice B reason: This choice is incorrect because a low-protein, low-potassium diet may not be necessary for a child who has acute glomerulonephritis. A low-protein, low-potassium diet may be indicated for a child who has chronic kidney disease or end-stage renal disease, which can cause uremia, hyperkalemia, or metabolic acidosis. However, in acute glomerulonephritis, the kidney function usually recovers within weeks or months, and the protein and potassium levels are not significantly affected.

Choice C reason: This choice is incorrect because a low-carbohydrate, low-protein diet may not be appropriate for a child who has acute glomerulonephritis. A low-carbohydrate, low-protein diet may be used for a child who has diabetes mellitus or ketosis-prone epilepsy, which can cause hyperglycemia or ketone production. However, in acute glomerulonephritis, carbohydrate metabolism is not impaired, and the protein intake should be adequate to prevent malnutrition and promote healing.

Choice D reason: This choice is correct because a low-sodium, fluid-restricted diet is an appropriate diet for a child who has acute glomerulonephritis. A low-sodium, fluid-restricted diet helps to reduce the fluid retention and hypertension by limiting the sodium and water intake and excretion. The sodium intake should be less than 2 g per day, and the fluid intake should be equal to the urine output plus 500 mL per day.