A nurse is performing an annual wellness exam on an 8-year-old child whose last exam was one year ago. Which of the following findings should the nurse report to the provider?

Rationale:

A. Contact the client's family to discuss the decision: While family members may be involved, the nurse must prioritize respecting the client’s autonomy. The client has expressed their wishes, and involving family without consent may violate confidentiality and autonomy.

B. Encourage the client to complete a final hemodialysis treatment: Pressuring or encouraging a client to undergo treatment they have refused especially when they have advance directives in place disregards their legal and ethical right to make decisions about their own care.

C. Discuss possible options for discharge with the client: Respecting the client’s decision and exploring care planning, such as hospice or palliative care services, is appropriate. This supports autonomy while ensuring comfort and dignity in the end-of-life process.

D. Discuss future treatment options with the client's health care surrogate: A surrogate decision-maker is only consulted when the client is unable to make decisions. In this case, the client is alert and capable, so the discussion should remain between the nurse and client.

Rationale for Correct Choices:

• Pain medication: Pain control is a primary concern in fracture management, especially in pediatric clients. This child reports a pain score of 4/10, indicating discomfort. Administering pain medication will reduce suffering and help prevent complications such as anxiety or guarding, which may impair healing.
• Limb immobilization: Immobilization stabilizes the fracture site and prevents further injury to soft tissues or neurovascular structures. With a nondisplaced fracture of both radius and ulna, the nurse should expect a splint or cast order to limit movement and aid in bone alignment and healing.

Rationale for Incorrect Choices:

• Bed rest: Bed rest is not required for isolated upper limb fractures, particularly when the child is developmentally appropriate, alert, and ambulatory. Encouraging mobility is important to reduce the risk of complications like deconditioning or thromboembolism.
• Surgical consultation: A nondisplaced fracture typically does not require surgical intervention unless complications develop. Surgical consultation is more often necessary for open, displaced, or unstable fractures that require reduction or fixation.
• Antibiotics: There are no signs of systemic or localized infection. The child has a superficial knee abrasion but no open fracture or wound that would necessitate prophylactic antibiotics. Therefore, antibiotic use is not indicated in this situation.