A patient with cystic fibrosis has blood glucose levels that are consistently between 180 to 250 mg/dL. Which action will the nurse expect to implement?

Choice A reason: Pulmonary edema involves fluid in alveoli, often from heart failure, not directly linked to pancytopenia. Low blood cell counts don’t cause fluid overload; this complication arises from cardiac or renal dysfunction, making it less relevant to pancytopenia’s hematologic deficits.

Choice B reason: Bleeding risk increases with pancytopenia due to thrombocytopenia, reducing platelet counts below 150,000/µL. Impaired clotting leads to spontaneous hemorrhage, such as petechiae or mucosal bleeding, a direct and common consequence of bone marrow suppression in this condition.

Choice C reason: Neurogenic shock results from spinal injury or autonomic dysfunction, causing vasodilation and hypotension. Pancytopenia affects blood cells, not neural regulation, so this complication isn’t a primary risk unless unrelated trauma or systemic failure occurs.

Choice D reason: Infection risk rises with pancytopenia from leukopenia, lowering white blood cells below 4,000/µL. Neutropenia impairs immune defense, increasing susceptibility to bacterial, fungal, or viral infections, a frequent and severe complication requiring vigilant monitoring in these patients.

Choice E reason: Seizures stem from neurologic or metabolic disturbances, like hypoglycemia, not pancytopenia. Reduced blood cells don’t directly affect brain excitability or seizure threshold, making this an unlikely complication unless secondary to infection or bleeding.

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.