A nurse is reinforcing teaching about immunizations with the parents of a newborn. Which of the following statements should the nurse make?

A. Determine if the toddler is voiding: Assessing urine output is crucial for determining the child’s hydration status. Voiding is an important indicator of kidney function and fluid balance. Ensuring the child is voiding can help determine the severity of dehydration and guide further interventions.

B. Request evaluation of the toddler's serum electrolytes. Evaluating serum electrolytes is important for understanding the extent of dehydration and electrolyte imbalances. However, it is not the immediate first action and should follow the initial assessment of the child's hydration status.

C. Initiate isotonic fluids with 20 mEq/L potassium chloride. Initiating fluid therapy is crucial but should only be done after assessing kidney function through urine output and evaluating the need for potassium supplementation to avoid complications like hyperkalaemia if the kidneys are not functioning properly.

D. Collect a stool sample from the toddler. Collecting a stool sample is useful for diagnosing the cause of gastroenteritis, but it is not the immediate priority. The focus should first be on assessing hydration status and initiating appropriate fluid therapy.

A. Perform range-of-motion (ROM) exercises to the infant's hips. ROM exercises are not the priority for an infant with spina bifida and could potentially cause harm if not done properly, particularly if the lesion is in a sensitive area.

B. Place the infant in a prone position. This is the correct action as it helps prevent pressure on the spina bifida lesion and minimizes the risk of injury or infection to the exposed spinal cord or meninges.

C. Feed the infant through an NG tube. An NG tube is not typically necessary for feeding infants with spina bifida unless there are other complicating factors that affect feeding.

D. Cover the infant's lesion with a dry cloth. The lesion should be covered with a sterile, moist, and non-adhesive dressing to prevent infection and keep the area moist. A dry cloth could cause the lesion to dry out and increase the risk of infection or damage.