A nurse is monitoring an infant who is receiving opioids for pain.
Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect?

Choice A rationale:

Soaking combs and brushes in boiling water for 10 minutes is a good practice to kill scabies mites that might be present on these items. However, it's not the primary mode of transmission for scabies. Scabies spreads through direct, prolonged, skin-to-skin contact with a person who has scabies. While cleaning items like combs and brushes is essential, treating close contacts is more critical to prevent reinfestation.

Choice B rationale:

Treating everyone who came into close contact with the child is the correct approach. Scabies is highly contagious and can easily spread to family members and close contacts. To effectively control the spread of the infestation, everyone who has been in close contact with the infested person should be treated simultaneously, even if they do not show symptoms.

Choice C rationale:

Applying petroleum jelly to the affected areas is not a recommended treatment for scabies. Scabies is caused by the Sarcoptes scabiei mite burrowing into the skin, and petroleum jelly does not effectively kill the mites. Medicated creams or lotions prescribed by a healthcare provider are the standard treatment for scabies.

Choice D rationale:

Washing the child's hair with shampoo containing ketoconazole is not a recommended treatment for scabies. Ketoconazole is an antifungal medication and is not effective against scabies mites. The primary treatment for scabies involves topical medications, such as permethrin cream or oral medications in severe cases.

Choice A rationale:

Limiting fluids at bedtime is not a suitable instruction for a child with sickle cell disease. These patients are at risk of dehydration due to increased red blood cell destruction, and limiting fluids can exacerbate this condition, leading to vaso-occlusive crises and pain episodes.

Choice B rationale:

Applying cold compresses to painful areas might provide temporary relief for pain associated with sickle cell disease, but it does not address the overall management of the illness. Encouraging physical activity, on the other hand, is essential as it promotes overall health and can prevent complications like thrombosis.

Choice C rationale:

Encouraging physical activity as tolerated is the correct choice. Regular physical activity helps improve circulation and can reduce the risk of vaso-occlusive crises in patients with sickle cell disease. The nurse should advise the guardians to encourage the child to engage in activities that are appropriate for their age and physical condition, while also being mindful of any signs of fatigue or pain.

Choice D rationale:

Having the child wear a surgical mask to school is not relevant to the management of sickle cell disease. This measure is more appropriate for preventing the spread of contagious diseases and is not a specific intervention for sickle cell disease management.