A nurse is planning to administer 2 units of packed RBCs to an older adult client who has anemia. Which of the following actions should the nurse plan to take? (Select all that apply.)

Rationale:

A. Administer Ibuprofen 200 mg PO: The child reports a pain score of 5/10 and is requesting pain medication. The provider has prescribed ibuprofen PRN for this level of pain. Prompt administration supports comfort and reduces inflammation associated with fracture and swelling.

B. Elevate the affected forearm with pillows: Elevation helps reduce edema by promoting venous return and lymphatic drainage. Given the child's worsening edema in the forearm and fingers, this is a priority to minimize complications like compartment syndrome.

C. Place a nonadherent dressing on the right knee abrasion: Although dressing the abrasion is a reasonable intervention, it is not a priority at this stage. The abrasion is not actively bleeding or infected, so attention should remain on managing neurovascular risk and pain.

D. Review cast care instructions with the child's parents: This is an important educational step, but it is not a current priority since the cast has not yet been applied. Priority actions should focus on pain, swelling, and circulation while awaiting casting.

E. Apply ice packs to the fingers and along the right forearm: Ice helps manage pain and inflammation by vasoconstriction, limiting fluid accumulation in tissues. Applying it early post-injury is crucial to controlling swelling in a fractured limb.

F. Explain the cast application procedure to the child: Preparing the child for a future procedure is helpful but not immediately necessary. At this point, pain control and reduction of swelling take precedence to prevent complications and stabilize the injury.

Rationale:

• Parotid glands: Parotid gland enlargement is a typical finding in clients with bulimia nervosa due to repeated episodes of self-induced vomiting. The recurrent stimulation of salivary glands leads to painless swelling, often bilateral, and may also contribute to facial puffiness or a rounded appearance.
• Potassium level: A potassium level of 3.0 mEq/L is low and may result from either bulimia nervosa or anorexia nervosa. In bulimia, this is typically due to purging through vomiting or laxative use; in anorexia, it stems from prolonged restriction, dehydration, and possible diuretic misuse. Both conditions increase the risk of cardiac complications.
• Weight: The client’s weight of 61.8 kg with a BMI of 20.7 falls within the normal range and is more consistent with bulimia nervosa. Individuals with anorexia nervosa usually present with a significantly lower body weight and BMI, typically below 18.5, due to extreme caloric restriction and prolonged starvation.
• Sodium level: A sodium level of 134 mEq/L is slightly low and can occur in both bulimia nervosa and anorexia nervosa. In bulimia, frequent vomiting may cause sodium loss, while in anorexia, hyponatremia can develop from malnutrition, dehydration, or excessive water intake in attempts to suppress appetite or manipulate weight.
• Hand findings: Calluses on the index and middle fingers, known as Russell’s sign, are associated with bulimia nervosa. These result from repeated trauma during induced vomiting episodes, as the hand comes into contact with the teeth. This finding is a classic physical sign of chronic purging behavior.