A nurse is reinforcing teaching with a client who has cancer and is undergoing external radiation therapy. Which of the following instructions should the nurse include in the teaching?

A) Regresses to an earlier developmental level:
While it is possible for a child to show some regression in behavior when faced with a stressful situation such as a sibling’s illness, school-age children are typically able to understand more complex concepts. Regression to an earlier developmental stage is more common in younger children (preschool-age) rather than school-age children, who are more likely to express their emotions in other ways.

B) Alienates himself from his peers:
While the child may experience feelings of isolation or withdrawal due to the stress of a sibling’s terminal illness, alienation from peers is not the most typical or immediate response for a school-age child. It is more common for children of this age to seek comfort and support from peers, though they may struggle with how to discuss their feelings.

C) Believes that his brother's death will be reversible:
At a school-age level, children generally begin to understand the permanence of death. While younger children may have magical thinking that could lead them to believe the death of a loved one could be reversible, this is not the expected response for a school-age child. By this age, children typically comprehend that death is final, although they may struggle with the emotional aspect of it.

D) Believes his bad behavior is causing his brother's death:
This response is the most typical for a school-age child. At this stage, children often have a sense of responsibility for events around them and may develop feelings of guilt or magical thinking, where they believe their actions or behavior contributed to the illness or death of a loved one. This belief is part of the normal coping process but needs to be addressed in counseling or with support from caregivers to help the child understand the situation and alleviate any misplaced guilt.

A) Place the client in Sims' position for catheter insertion: Sims' position (side-lying position) is not typically used for central venous catheter insertion. The client is usually placed in a supine or Trendelenburg position to help facilitate insertion and decrease the risk of air embolism during the procedure.

B) Prepare the client for a chest x-ray to verify catheter placement: After the insertion of a central venous catheter, a chest x-ray is routinely performed to verify the correct placement of the catheter in the superior vena cava or right atrium. This is essential to ensure the catheter is properly positioned and to check for complications like pneumothorax or inadvertent placement in the lung.

C) Use clean technique when changing the catheter dressing: When changing the dressing for a central venous catheter, sterile technique is required, not clean technique. Sterile technique minimizes the risk of infection, which is a major concern when caring for central venous access devices.

D) Verify the amount of TPN solution the client is receiving every 4 hr: While it is important to monitor the amount of TPN being infused and assess for complications, verifying the exact amount every 4 hours is not a standard procedure. Typically, TPN is managed and adjusted by the healthcare provider based on lab results, weight, and clinical status, but constant monitoring of the solution is not required.