A nurse is caring for a school-age child who has acute otitis media and a new prescription for clindamycin. Which of the following findings indicates the child is experiencing an allergic reaction to the medication?

Choice A rationale:
Lethargy, or extreme fatigue and sluggishness, is a characteristic symptom of hypothyroidism. Hypothyroidism occurs due to an underactive thyroid gland, which leads to a decrease in metabolic activity and energy levels. Children with hypothyroidism often exhibit lethargy, weakness, and a lack of interest in activities. This is due to the reduced metabolic rate and overall slowing down of bodily functions.
Choice B rationale:
Diarrhea is not a common finding associated with hypothyroidism. In fact, hypothyroidism tends to slow down gastrointestinal motility, leading to constipation rather than diarrhea. Therefore, diarrhea is not expected as a symptom in a child with hypothyroidism.
Choice C rationale:
Tachycardia, an elevated heart rate, is not typically associated with hypothyroidism. Instead, hypothyroidism often leads to bradycardia (a slower-than-normal heart rate) due to the overall slowing of the body's metabolic processes.
Choice D rationale:
Hirsutism, which refers to excessive hair growth in areas where hair growth is typically seen in males, is not a common finding in hypothyroidism. Hirsutism is more commonly associated with hormonal imbalances such as polycystic ovary syndrome (PCOS) rather than hypothyroidism.

The correct answer is Choice D.

Choice A rationale: Administering an oral corticosteroid is not the first action the nurse should take. Corticosteroids are used to reduce inflammation and itching caused by poison ivy. However, they are usually prescribed if the symptoms are severe or if the rash covers a large area of the body. It’s important to note that corticosteroids can have side effects, especially when used for a long time, so they should be used under the supervision of a healthcare provider.

Choice B rationale: Applying calamine lotion to the affected area can help soothe the skin and relieve itching caused by poison ivy. However, this is not the first action the nurse should take. The first step is to remove the oil from the skin that causes the allergic reaction. Calamine lotion can be applied after the area has been thoroughly washed.

Choice C rationale: Instructing the parent to give the child an oatmeal bath twice daily can help soothe the skin and relieve itching. However, this is not the first action the nurse should take. Similar to calamine lotion, an oatmeal bath can be beneficial after the area has been thoroughly washed to remove the oil from the skin.

Choice D rationale: The first action the nurse should take when caring for a child exposed to poison ivy is to flush the area with cold, running water. This helps to remove the oil (urushiol) from the skin that causes the allergic reaction. It’s important to do this as soon as possible after exposure to help prevent the spread of the oil to other areas of the body or to other people. After flushing the area, the nurse can then apply calamine lotion or recommend an oatmeal bath to help soothe the skin and relieve itching.