A nurse is providing teaching to the parents of a preschool-age child who has celiac disease. Which of the following instructions should the nurse Include?

"Your child will need to follow a low-protein diet temporarily."

"You should place your child on a high-fiber diet when she has an exacerbation."

"You should replace white flour with wheat flour when preparing meals for your child."

"Your child will be on a gluten-free diet for the rest of her life."

Answer and Explanation

The Correct Answer is D

A. "Your child will need to follow a low-protein diet temporarily." Celiac disease requires a gluten-free diet, not a low-protein diet. Protein intake is not typically restricted in celiac disease unless there are specific renal issues.

B. "You should place your child on a high-fiber diet when she has an exacerbation." High-fiber diets are not specific to managing celiac disease exacerbations. The focus should be on a gluten-free diet to avoid triggering symptoms.

C. "You should replace white flour with wheat flour when preparing meals for your child." This advice is incorrect as both white flour and wheat flour contain gluten. The child should avoid all gluten-containing products, including wheat flour.

D. "Your child will be on a gluten-free diet for the rest of her life." Correct. Celiac disease is a lifelong condition that requires a strict gluten-free diet to prevent symptoms and long-term complications.

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Correct Answer is ["A","B","E","H"]

Explanation

5 appropriate interventions:

A. Administer folic acid as prescribed. Folic acid is important for patients with sickle cell disease because it helps produce new red blood cells. Chronic hemolysis (destruction of red blood cells) is a hallmark of sickle cell disease, and folic acid supplementation aids in counteracting the effects of anemia by promoting red blood cell production.

B. Monitor oxygen saturation continuously. Continuous monitoring of oxygen saturation is crucial because hypoxia (low oxygen levels) can exacerbate sickling of red blood cells, leading to increased pain and vaso-occlusive events. Ensuring adequate oxygenation helps prevent further complications and supports overall management of the crisis.

E. Instruct the parent to ensure the pneumococcal vaccine is current. Patients with sickle cell disease are at increased risk for infections, including pneumococcal infections, due to functional asplenia (reduced spleen function). Ensuring vaccinations are up to date is a preventive measure to protect against serious infections, which can trigger or worsen a vaso-occlusive crisis.

H. Give oral hydroxyurea. Hydroxyurea is a medication used in the long-term management of sickle cell disease. It increases fetal hemoglobin (HbF) production, which helps reduce the frequency of vaso-occlusive crises and other complications by decreasing the sickling of red blood cells. It is part of a comprehensive approach to managing sickle cell disease.

Interventions to avoid:

C. Apply cold compresses to the affected joints:

Cold can cause vasoconstriction, which may worsen pain and decrease blood flow to the affected area, exacerbating the vaso-occlusive crisis. Instead, warm compresses are typically recommended to promote vasodilation and blood flow.

D. Restrict oral intake:

Hydration is crucial in managing vaso-occlusive crises. Restricting oral intake could lead to dehydration, which can increase blood viscosity and worsen the crisis. Patients should be encouraged to maintain adequate fluid intake.

F. Place the client on strict bed rest.

While rest is important, strict bed rest is not generally recommended as it can increase the risk of complications such as deep vein thrombosis. Patients should be encouraged to engage in light activity as tolerated to maintain circulation.

A. Double vision B. Nuchal rigidity when standing C. Pain in the posterior iliac crest D. Headache

Correct Answer is D

Explanation

A. Double vision: Double vision is not a common complication of a lumbar puncture. Complications typically involve symptoms related to cerebrospinal fluid (CSF) leakage or infection.

B. Nuchal rigidity when standing: Nuchal rigidity (stiff neck) can indicate meningitis, but it is not specifically a complication of a lumbar puncture. Nuchal rigidity is more likely to be associated with an underlying condition that prompted the lumbar puncture rather than the procedure itself.

C. Pain in the posterior iliac crest: Pain at the posterior iliac crest is not typical after a lumbar puncture, as the procedure is performed in the lower back at the lumbar spine region.

D. Headache: Headache is a common complication following a lumbar puncture, often due to a CSF leak. The headache typically worsens when the patient is in an upright position and improves when lying down.

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A nurse is providing teaching to the parents of a preschool-age child who has celiac disease. Which of the following instructions should the nurse Include?

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