Select the 3 client statements that indicate an understanding of the teaching.

A) Request an x-ray of the neck: In cases of suspected epiglottitis, a lateral neck x-ray can help confirm the diagnosis by showing the classic "thumbprint sign," which indicates swelling of the epiglottis. This is a critical diagnostic step, but it should only be performed in a controlled setting where the child’s airway can be monitored closely. The priority is to avoid any procedures that may cause irritation or further compromise the airway.

B) Monitor urine for protein: Monitoring urine for protein is not relevant to the management of epiglottitis. This condition is related to inflammation and obstruction of the upper airway, and the focus should be on respiratory management rather than renal function.

C) Obtain a nasopharyngeal swab: While obtaining a nasopharyngeal swab can help identify the organism causing an infection (often bacterial), it is not the immediate priority in a child with suspected epiglottitis. The child’s airway is the most critical concern, and diagnostic interventions that could potentially cause further distress or obstruction (such as swabbing) should be avoided until airway management is stable.

D) Administer fluconazole: Fluconazole is an antifungal medication, and its use is not appropriate for epiglottitis. Epiglottitis is most often caused by a bacterial infection, particularly Haemophilus influenzae type b (Hib), which requires antibiotic therapy, not antifungals.

A) Assist the client with range-of-motion exercises of the hands:
This task is appropriate for the assistive personnel (AP) as it is a routine, non-invasive intervention that can help maintain mobility and prevent contractures in the hands. The AP can assist with range-of-motion exercises, following proper technique, and reporting any abnormalities to the nurse. This falls within the AP's scope of practice and can be delegated to them effectively.

B) Determine the circulation status of the affected extremities every hr:
Assessing circulation is a nursing responsibility and requires clinical judgment to identify signs of impaired circulation, such as color changes, pulse, or temperature of the skin. This task cannot be delegated to an AP, as it requires a nurse’s skill to interpret findings and take appropriate action.

C) Instruct the client's family about the purpose of mitten restraints:
Educating the client's family about the use of mitten restraints is a responsibility of the nurse, not the AP. This involves assessing the family’s understanding, providing relevant information, and answering any questions they may have. Only licensed healthcare professionals are responsible for providing education about the purpose and use of restraints.

D) Evaluate the need for the client to remain in mitten restraints:
Evaluating the necessity of restraints involves assessing the client's condition, safety, and overall care needs. This requires critical thinking and professional judgment and should be performed by the nurse, not the AP. The nurse must determine if the restraints continue to be necessary or if they can be removed, ensuring the client’s safety and dignity.