A nurse is caring for a client who has a history of chronic obstructive pulmonary disease (COPD) and is receiving oxygen therapy at home. The nurse should instruct the client to report which of the following findings as an indication of oxygen toxicity?

Choice A reason: This is the correct instruction for the nurse to include in the plan. Mumps is a viral infection that causes inflammation of the salivary glands. It is transmitted by respiratory droplets from coughing, sneezing, or talking. The nurse should initiate droplet precautions, which include wearing a surgical mask, gloves, and gown, and keeping the child in a private room or with other children who have mumps.

Choice B reason: This is not the correct instruction for the nurse to include in the plan. Airborne precautions are used for infections that are transmitted by small particles that can remain suspended in the air for long periods of time, such as tuberculosis, chickenpox, or measles. Mumps is not an airborne infection, and the nurse does not need to wear a respirator or place the child in a negative pressure room.

Choice C reason: This is not the correct instruction for the nurse to include in the plan. Contact precautions are used for infections that are transmitted by direct or indirect contact with the infected person or their environment, such as scabies, impetigo, or MRSA. Mumps is not a contact infection, and the nurse does not need to wear gloves and gown for all interactions with the child or use disposable equipment.

Choice D reason: This is not the correct instruction for the nurse to include in the plan. Standard precautions are the minimum level of infection control that should be used for all patients, regardless of their diagnosis or presumed infection status. They include hand hygiene, use of personal protective equipment, safe injection practices, and environmental cleaning. However, they are not sufficient for preventing the transmission of mumps, and the nurse should use additional precautions.

Choice A reason: Encouraging the child to take a 45 min nap daily is not a helpful instruction, as it may interfere with the child's normal sleep pattern and school schedule. The child may benefit from regular rest periods throughout the day, but not necessarily a long nap. ⁵

Choice B reason: Administering prednisone on an alternate day schedule is a helpful instruction, as it is a common way of prescribing corticosteroids for children with juvenile idiopathic arthritis. Corticosteroids are used to reduce inflammation and control symptoms, but they have many side effects, such as growth suppression, weight gain, and osteoporosis. Giving the medication every other day may reduce some of these side effects and improve compliance. ⁶

Choice C reason: Applying cool compresses for 20 min every hour is not a helpful instruction, as it may cause skin damage and discomfort. Cool compresses may be useful for acute inflammation, but not for chronic arthritis. Warm compresses or baths may be more soothing and beneficial for the child's joints. ⁷

Choice D reason: Allowing the child to stay at home on days when her joints are painful is not a helpful instruction, as it may lead to social isolation, academic difficulties, and reduced physical activity. The child should be encouraged to attend school and participate in activities as much as possible, with appropriate accommodations and modifications if needed. The child may also benefit from physical therapy, occupational therapy, and pain management strategies. ⁸