A patient comes to the doctor’s office with the following complaints: Moderate to severe pain over the nose, eyes, and forehead, purulent nasal drainage, fever, and malaise. The nurse suspects the patient is suffering from ___________.

Choice A reason: Community-acquired pneumonia (CAP) fits symptoms like cough or fever from pathogens outside hospitals. It’s the most likely without hospital exposure history, aligning with typical outpatient respiratory infection patterns.

Choice B reason: Cor pulmonale involves right heart failure from lung disease, not primary infection. Maria’s acute symptoms suggest pneumonia, not chronic pulmonary hypertension, making this less probable without supporting cardiac findings.

Choice C reason: Hospital-acquired pneumonia requires recent hospitalization, not indicated here. Maria’s presentation lacks nosocomial context, favoring community-acquired pneumonia as the diagnosis based on typical outpatient symptom onset.

Choice A reason: Restricting fluids to 2 liters per day increases blood viscosity in sickle cell disease, promoting sickling and vaso-occlusion. Adequate hydration is critical to dilute hemoglobin S, so this instruction contradicts evidence-based management for crisis prevention.

Choice B reason: Iron supplements are contraindicated in sickle cell disease unless anemia is iron-deficient, which is rare. Most patients have normal or high iron from hemolysis, so a multivitamin with iron risks overload and organ damage.

Choice C reason: Avoiding caffeine lacks evidence in sickle cell crisis prevention; it’s not a trigger. Moderate intake doesn’t dehydrate significantly or affect sickling, making this instruction irrelevant to discharge teaching for this condition.

Choice D reason: Limiting crowd exposure reduces infection risk, a common sickle cell crisis trigger. Infections cause inflammation and hypoxia, promoting sickling, so this instruction aligns with preventing complications and maintaining patient stability post-discharge.