A 6-year-old child was diagnosed as having streptococcal pharyngitis. At the follow-up visit, the nurse will assess the child for which potential complication?

Rationale:

• Hypoplastic Left Heart Syndrome is cyanotic because severe underdevelopment of the left heart structures leads to mixing of oxygenated and deoxygenated blood, causing systemic hypoxemia from birth.

• Transposition of the Great Arteries is cyanotic as the aorta and pulmonary artery are switched, creating two separate circulations where oxygenated blood does not reach the systemic circulation without a shunt.

• Atrial Septal Defect is acyanotic because it initially causes a left-to-right shunt, increasing pulmonary blood flow without significant desaturation until later complications develop.

• Coarctation of the Aorta is acyanotic since it involves narrowing of the aorta, leading to obstruction of blood flow rather than abnormal mixing, so oxygen saturation typically remains normal.

• Patent Ductus Arteriosus is acyanotic in early stages because blood flows from the higher-pressure aorta into the pulmonary artery, increasing pulmonary circulation without systemic desaturation.

• Tetralogy of Fallot is cyanotic due to the combination of four defects, including right ventricular outflow obstruction, which forces deoxygenated blood into the systemic circulation.

Rationale:

A. "This is a hereditary disease that is transmitted by one affected gene.": Sickle cell anemia is an autosomal recessive disorder requiring two copies of the mutated gene; having only one copy results in the trait, not the disease itself.

B. "Fluid restriction is necessary to control sickle cell anemia.": Adequate hydration is crucial in managing sickle cell anemia to prevent sickling crises, so fluid restriction is contraindicated.

C. "The sickle shape of red blood cells decreases oxygen to tissues.": The abnormal sickle shape reduces the cells’ ability to carry oxygen and causes vaso-occlusion, leading to decreased oxygen delivery to tissues, which is a key pathophysiological aspect of the disease.

D. "Sickle cell anemia is common in people of Asian descent.": The disease primarily affects individuals of African, Mediterranean, Middle Eastern, and Indian descent, not predominantly those of Asian descent.