The nurse is caring for an infant admitted with dehydration, irritability, signs of extreme hunger, and a palpable olive-like mass in the upper right abdominal quadrant. When feeding the infant, the nurse should monitor for which development?

Choice A reason: Encouraging the parent to come to the clinic if the child develops a fever is not the best response that the nurse can give. This is because a fever may indicate a serious infection, such as Lyme disease, that requires prompt treatment. The nurse should not wait for the child to develop a fever before advising the parent to seek medical attention.

Choice B reason: Instructing the parent to apply an antihistamine ointment for one week is not the best response that the nurse can give. This is because an antihistamine ointment may not be effective for a fungal infection, such as ringworm, or a bacterial infection, such as Lyme disease, that may cause a circular rash. The nurse should not recommend any OTC product without knowing the exact cause of the rash.

Choice C reason: Offering reassurance that OTC corticosteroid creams are safe and effective is not the best response that the nurse can give. This is because corticosteroid creams may worsen a fungal infection, such as ringworm, or mask the symptoms of a bacterial infection, such as Lyme disease, that may cause a circular rash. The nurse should not recommend any OTC product without knowing the exact cause of the rash.

Choice D reason: Explaining the need for the child to have an immediate medical evaluation is the best response that the nurse can give. This is because a circular rash can be a sign of a serious condition, such as Lyme disease, that requires urgent diagnosis and treatment. The nurse should inform the parent that the rash may not be ringworm, as many people assume, and that it may be caused by a tick bite or another factor. The nurse should also advise the parent to avoid touching or scratching the rash and to keep it clean and dry until the child sees a doctor.

Choice A reason: Rhabdomyolysis is not the probable cause of the findings. Rhabdomyolysis is a condition that occurs when damaged muscle tissue breaks down and releases substances into the bloodstream that can harm the kidneys. It is usually caused by trauma, infection, drugs, or extreme exercise. It does not cause radial ossification in the soft tissues, but rather dark urine, muscle weakness, and kidney failure.

Choice B reason: Osteosarcoma is the probable cause of the findings. Osteosarcoma is a type of bone cancer that usually affects the long bones of the arms and legs. It is more common in adolescents and young adults. It can cause pain, swelling, and limping in the affected area, as well as radial ossification in the soft tissues, which is a sign of tumor invasion.

Choice C reason: Growing pains are not the probable cause of the findings. Growing pains are a common cause of leg pain in children and adolescents, but they are not associated with any physical abnormality or disease. They usually occur in both legs, not just one, and they are more likely to affect the calves, shins, or thighs, not the knees. They do not cause swelling, tenderness, or radial ossification in the soft tissues.

Choice D reason: Hemosiderosis is not the probable cause of the findings. Hemosiderosis is a condition that occurs when excess iron deposits in the tissues, usually as a result of repeated blood transfusions or hemolytic anemia. It can affect various organs, such as the liver, lungs, heart, and skin, but not the bones. It does not cause pain, swelling, or radial ossification in the soft tissues, but rather fatigue, shortness of breath, chest pain, and skin discoloration.