A nurse is providing education to a client during a prenatal visit. Which of the following medications should the nurse include as contraindicated during pregnancy?

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.

Rationale:

A. Instruct the parent to give 5 mcg of vitamin D daily: While vitamin D supplementation is recommended for breastfed infants, this advice does not address the inappropriate introduction of cow’s milk, which can cause complications such as intestinal bleeding and iron deficiency in infants under 12 months.

B. Instruct the parent to give the infant water every 3 hr between feedings: Offering water to infants under 6 months is discouraged, as it can displace essential nutrients from breast milk or formula and increase the risk of water intoxication due to immature kidneys.

C. Advise the parent to avoid giving cow's milk to the infant prior to 1 year of age: Cow's milk is not suitable for infants under 12 months because it lacks adequate iron and nutrients, and its high protein content can irritate the immature kidneys and intestinal lining.

D. Recommend the parent mix the milk with rice cereal for feedings: Mixing cow’s milk with cereal does not resolve its nutritional inadequacy or potential risks. Introducing solids and allergenic foods should follow developmental readiness and established pediatric guidelines.