A nurse is reviewing new prescriptions for a client. The nurse should identify that which of the following abbreviations used by the provider indicates "to administer medications before meals"?

Explanation:

A. A 6-year-old child with a spiral fracture of the tibia and fibula, reportedly occurring while riding a bicycle:

While a spiral fracture can be concerning, it is also a common injury seen in children due to falls or accidents during physical activities such as riding a bicycle. Without further evidence or suspicion, this may not immediately indicate physical abuse.

B. A 14-month-old toddler reportedly learning to walk and has several bruises on bony prominences of the lower legs and elbows:

Bruises on bony prominences can be common in toddlers who are learning to walk and explore their environment. These bruises are often seen on areas such as the lower legs and elbows. Without additional concerning signs or patterns, this may not indicate physical abuse.

C. A 9-month-old infant who sustained near drowning when he reportedly climbed into the tub and turned on the water:

Near drowning incidents can occur accidentally, especially in curious and mobile infants who may explore their surroundings. While this is a serious event, it does not necessarily suggest physical abuse unless there are other suspicious findings or a history of non-accidental injuries.

D. A 3-year-old toddler with scalding burns over the face and chest reportedly sustained when the child pulled on a tablecloth, spilling a cup of tea on himself:

Scalding burns, especially over sensitive areas like the face and chest, can raise concerns about physical abuse, especially when the reported mechanism of injury (spilling a cup of tea) seems inconsistent or disproportionate to the severity of the burns. The pattern and location of burns may not align with accidental spillage, leading to suspicion of abuse.

Explanation:

A. Place the head of the client's bed flat:

This action is not appropriate because lying flat can worsen dyspnea in many cases. It can restrict lung expansion and make breathing more difficult. Instead, the nurse should elevate the head of the bed or position the client in a semi-Fowler's or high-Fowler's position to facilitate easier breathing.

B. Perform nasotracheal suctioning for the client:

Nasotracheal suctioning is not indicated for dyspnea unless there is a specific medical reason, such as airway obstruction or excessive secretions. Performing suctioning without a clear indication can cause discomfort and may not address the underlying cause of dyspnea.

C. Increase the heat in the client's room:

Adjusting the room temperature is generally not a direct intervention for dyspnea. While maintaining a comfortable environment is important, dyspnea is usually managed through other means such as medication and positioning.

D. Administer an opioid narcotic to the client:

This is the most appropriate action among the choices provided. Opioid narcotics, such as morphine, are commonly used to alleviate dyspnea in end-of-life care. They help reduce the sensation of breathlessness, calm respiratory distress, and improve overall comfort for the client.