A nurse is caring for an adolescent who has sickle-cell anemia. Which of the following manifestations indicates acute chest syndrome and should be immediately reported to the provider?

Hematuria

Sneezing

Substernal retractions

Temperature 37.9° C (100.2° F)

Answer and Explanation

The Correct Answer is C

Rationale:

A. Hematuria: Blood in the urine can occur with sickle cell disease due to renal papillary necrosis, but it is not specific to acute chest syndrome and does not require immediate emergency action in this context.

B. Sneezing: Sneezing is typically associated with upper respiratory infections or allergies and is not indicative of acute chest syndrome. It is not a critical symptom in this scenario.

C. Substernal retractions: Substernal retractions are a sign of respiratory distress and can indicate acute chest syndrome a life-threatening complication of sickle cell anemia. It involves pulmonary infiltration and can rapidly progress to hypoxia and respiratory failure, requiring urgent intervention.

D. Temperature 37.9° C (100.2° F): While fever in a sickle cell client should be closely monitored and reported, this temperature is low-grade. Alone, it does not immediately signal acute chest syndrome without accompanying respiratory symptoms.

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Correct Answer is A

Explanation

Rationale:

A. "I should avoid over-the-counter medications that contain alcohol.": Disulfiram causes an unpleasant reaction when alcohol is consumed, even in small amounts. Clients must avoid alcohol-containing products such as certain cough syrups, mouthwashes, and topical solutions to prevent serious adverse effects like flushing, nausea, and hypotension.

B. "I will need to get a monthly injection of this medication.": Disulfiram is an oral medication taken daily, not administered via monthly injection. The injectable form is associated with other medications used in substance use disorder treatment, such as naltrexone.

C. "My provider wants me to take this medication for 2 weeks before I try to quit drinking.": Disulfiram is intended for clients who have already stopped drinking. It is not used to initiate abstinence but to maintain it by discouraging alcohol use through aversive effects.

D. "I will plan to continue taking this medication for at least 5 years.": The duration of disulfiram therapy varies based on the client’s progress and treatment plan. Long-term use beyond 1–2 years is uncommon and typically guided by continued risk of relapse and provider judgment.

A. Expresses pain freely and loudly B. Prefers foods that maintain a balance of hot and cold within the body. C. Prefers to make direct eye contact with health care personnel D. Tends to be very expressive with gestures and body language

Correct Answer is B

Explanation

Rationale:

A. Expresses pain freely and loudly: Many Chinese American clients may view overt pain expression as a loss of control or dignity. Cultural norms often encourage stoicism, and clients may underreport pain unless directly asked in a sensitive and respectful manner.

B. Prefers foods that maintain a balance of hot and cold within the body: Traditional Chinese medicine emphasizes balance, particularly of hot and cold elements, especially during the postpartum period. Clients may prefer warm foods and drinks to restore balance and promote healing after childbirth.

C. Prefers to make direct eye contact with health care personnel: In Chinese cultural contexts, direct eye contact can be considered disrespectful or confrontational, especially toward authority figures. Avoiding eye contact may be a sign of respect rather than disinterest.

D. Tends to be very expressive with gestures and body language: Chinese American clients may communicate in a more reserved and controlled manner, often minimizing the use of expressive gestures. Nonverbal communication may be subtle, requiring attentive observation.

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Finding	Nursing Intervention
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A nurse is caring for an adolescent who has sickle-cell anemia. Which of the following manifestations indicates acute chest syndrome and should be immediately reported to the provider?

Nursing Test Bank

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Explanation

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Explanation

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