A nurse is planning care for an adolescent who has sickle cell anemia.
Which of the following immunization should the nurse include in the plan?

The correct answer is choiced. Encourage the adolescent to perform incentive spirometry to maintain lung capacity.

Choice A rationale: Avoiding influenza and pneumococcal vaccines for 24 months is not recommended. Vaccinations are crucial for preventing respiratory infections, which can be particularly dangerous for individuals with muscular dystrophy due to their compromised respiratory function.

Choice B rationale: Initiating a referral for chest physiotherapy every 4 hours is excessive and impractical. While chest physiotherapy can be beneficial, it is typically recommended at a frequency that is manageable and tailored to the individual’s needs.

Choice C rationale: Recommending the adolescent use a wheelchair to prevent stress on the lower extremities is not ideal. Encouraging mobility and physical activity as tolerated is important to maintain muscle strength and function for as long as possible.

Choice D rationale: Encouraging the adolescent to perform incentive spirometry to maintain lung capacity is appropriate. Incentive spirometry helps improve lung function and prevent respiratory complications, which are common in individuals with muscular dystrophy.

The correct answer is A. Antibiotics initiated 24 hr ago.

Explanation:

Children with bacterial meningitis require droplet precautions to prevent the spread of infection. These precautions can typically be discontinued after 24 hours of effective antibiotic therapy, as the risk of transmission significantly decreases.

Why the other options are incorrect:

• B. Negative cerebrospinal fluid (CSF) culture – While a negative CSF culture confirms the absence of bacteria, cultures may take several days to process. Droplet precautions are usually lifted based on treatment duration, not pending lab results.

• C. Absent nuchal rigidity – Nuchal rigidity (stiff neck) is a symptom of meningitis, but its resolution does not determine infectious risk.

• D. Temperature below 37.4°C (99.4°F) – Fever reduction is a sign of improvement but does not indicate that the infection is no longer transmissible.