A nurse is creating a plan of care for a child who has sickle cell anemia. Which of the following interventions should the nurse include in the plan?

Choice A reason: Changes in the voice signal the beginning of puberty is incorrect, as voice changes usually occur in the middle or late stages of puberty, not the beginning. The first sign of puberty in boys is usually testicular enlargement, followed by pubic hair growth and penile enlargement.

Choice B reason: Growth spurts in height occur toward the end of mid-puberty is correct, as this is the typical pattern of growth for boys during puberty. Boys usually start their growth spurt later than girls, but grow faster and for a longer period of time.

Choice C reason: Puberty might be delayed if scrotal changes have not occurred by the age of 11 years is incorrect, as this is not a definitive indicator of delayed puberty. Puberty can vary widely among individuals, and some boys may start later than others without any underlying problem. Delayed puberty is usually diagnosed if there is no sign of puberty by the age of 14 years.

Choice D reason: Gynecomastia commonly occurs during late puberty is incorrect, as gynecomastia, or the enlargement of breast tissue in males, usually occurs in the early or middle stages of puberty, not the late stage. It is caused by hormonal changes and usually resolves on its own within a few months or years.

Choice A reason: Continuing to monitor the client is not the best action, as it does not address the low urine output of the child. The child has a urine output of 20 mL/hr, which is below the expected range of 30 to 40 mL/hr for a 3-year-old child. Low urine output can indicate dehydration, kidney injury, or urinary tract obstruction, which require prompt intervention.

Choice B reason: Performing a bladder scan at the bedside is not the most appropriate action, as it is not the first-line diagnostic tool for low urine output. A bladder scan is a noninvasive ultrasound device that measures the amount of urine in the bladder. It can help detect urinary retention, which is the inability to empty the bladder completely. However, urinary retention is unlikely in a 3-year-old child, and a bladder scan may not be accurate or reliable in children.

Choice C reason: Providing oral rehydration fluids is the best action, as it can help restore the fluid and electrolyte balance of the child. Oral rehydration fluids are solutions that contain water, sugar, and salt in specific proportions that match the body's needs. They can prevent or treat dehydration, which is a common cause of low urine output in children. The nurse should offer the child oral rehydration fluids every 15 to 20 minutes, and monitor the urine output, vital signs, and hydration status.

Choice D reason: Notifying the provider is not the first action, as it is not the most urgent or effective intervention for low urine output. The nurse should notify the provider after providing oral rehydration fluids and assessing the child's response. The nurse should also report any signs or symptoms of dehydration, such as dry mucous membranes, sunken eyes, poor skin turgor, or lethargy. The provider may order further tests or treatments, such as blood tests, urine tests, or intravenous fluids.