A nurse is collecting data from a 3-year-old child. Which of the following developmental milestones should the nurse expect the child to demonstrate?

A: Suctioning the client's airway every 2 hours is not indicated based on the provided information. The adolescent does not have a condition that compromises airway clearance, and routine suctioning can cause trauma or stimulate a vagal response, potentially leading to bradycardia.

B: Maintaining the client's head of the bed at 30° is appropriate for reducing intracranial pressure and facilitating venous drainage. The patient's symptoms of nuchal rigidity and severe headache suggest increased intracranial pressure, possibly due to meningitis, which is supported by the diagnostic results.

C: Keeping the client's room well lit is not advisable as the patient reports photophobia, which is a sensitivity to light. A well-lit room could exacerbate discomfort and pain.

D: Checking the client's temperature every 8 hours is important but not the priority intervention. The patient's condition requires more frequent monitoring due to the positive blood culture and sensitivity, indicating an active infection. More frequent temperature checks would be warranted.

Choice A reason:

Administering naloxone is not indicated for a seizure. Naloxone is used to reverse opioid overdose, not treat seizures.

Choice B reason:

Checking inside the child's mouth for bleeding is important after a seizure to ensure there is no injury to the oral cavity.

Choice C reason:

Giving the child a drink of water immediately after a seizure is not a priority intervention. The child may not be able to swallow properly immediately after a seizure.

Choice D reason:

Placing the child's head in a hyperextended position is not a recommended intervention after a seizure. It is important to maintain the child in a safe position and provide appropriate care after the seizure has ended.