The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood. What is the most appropriate initial nursing action?

The correct answer is choice B. Administer supplemental oxygen before and after suctioning.

Choice A rationale:

Expect symptoms of respiratory distress when suctioning. While respiratory distress can occur during and after suctioning, it is not the main nursing consideration. The primary goal is to minimize any potential complications and ensure the child's safety during the procedure, which can be achieved by following appropriate guidelines.

Choice B rationale:

Administer supplemental oxygen before and after suctioning. Correct Answer. Administering supplemental oxygen before and after suctioning is crucial to maintain adequate oxygenation during and after the procedure. Suctioning can temporarily decrease oxygen levels and cause desaturation, especially in a child who has undergone heart surgery. Providing supplemental oxygen helps prevent hypoxia and supports respiratory function.

Choice C rationale:

Perform suctioning at least every hour. Frequent suctioning at least every hour is not a standard nursing practice, especially for a child who has had heart surgery. Suctioning should only be performed as needed based on the child's clinical condition, and excessive suctioning can irritate the airway and lead to complications.

Choice D rationale:

Suction for no longer than 30 seconds at a time. While limiting the duration of suctioning is important to prevent hypoxia and trauma to the airway, the specific duration of 30 seconds is not a universal rule. Suctioning should be performed for the shortest effective duration to minimize the risk of complications, but the optimal time can vary based on the child's condition and the type of suctioning being used.

The correct answer is choice A. Meconium ileus.

Choice A rationale:

Meconium ileus. This is the earliest recognizable clinical manifestation of cystic fibrosis (CF). Meconium ileus refers to the blockage of the small intestine by thick, sticky meconium, the earliest stool of a newborn. It occurs in the first 24-48 hours of life and can be a sign of underlying cystic fibrosis.

Choice B rationale:

Foul-smelling, frothy, greasy stools. Foul-smelling, frothy, greasy stools are characteristic of malabsorption, which can occur in cystic fibrosis. However, this manifestation typically appears after meconium ileus and is not the earliest recognizable clinical sign.

Choice C rationale:

History of poor intestinal absorption. While poor intestinal absorption is a common consequence of cystic fibrosis, it is not one of the earliest recognizable clinical manifestations. Meconium ileus takes precedence as the primary early sign.

Choice D rationale:

Recurrent pneumonia and lung infections. Recurrent pneumonia and lung infections are common in later stages of cystic fibrosis due to the buildup of thick mucus in the respiratory tract. However, they are not among the earliest recognizable clinical manifestations of the disease. Meconium ileus is the earliest indicator in this context.