The nurse is administering methylergonovine 0.2 mg to a healthy postpartum client with uterine atony.

Choice A rationale

Administering an iron supplement daily is contraindicated unless the child has a diagnosed iron deficiency. Sickle cell anemia is characterized by a hemolytic process, where red blood cells are destroyed prematurely. This leads to a higher-than-normal iron level in the body, as the iron from the destroyed cells is released. Unnecessary iron supplementation can lead to iron overload, which can be toxic to the body.

Choice B rationale

Encouraging long-distance running is not advised for a child with sickle cell anemia. Strenuous physical activity can lead to dehydration and hypoxemia, which are major triggers for a sickle cell crisis. The increased metabolic demand on the body during such activities can promote sickling of red blood cells, leading to vaso-occlusion and severe pain.

Choice C rationale

Limiting the child's fluid intake is a dangerous practice. Dehydration is a major trigger for sickling of red blood cells. When the body is dehydrated, the blood becomes more concentrated, and the red blood cells are more likely to deform into the characteristic sickle shape. Adequate hydration is essential to maintain blood volume and prevent a crisis.

Choice D rationale

An upper respiratory infection can be a trigger for a sickle cell crisis. Infections, especially those that cause fever, increase the body's metabolic rate and can lead to dehydration and acidosis. These physiological changes promote the sickling of red blood cells, which can block blood vessels and cause a painful crisis. Prompt medical attention is crucial to manage the infection and prevent a crisis.

Choice A rationale

Nasopharyngitis is caused by a virus, not bacteria. Antibiotics are ineffective against viruses and their use in this context promotes antibiotic resistance. The routine prescription of antibiotics for a viral infection is not evidence-based practice and is discouraged by public health authorities. Treatment is focused on symptom management, not eradication of the underlying virus.

Choice B rationale

A cough is a protective physiological reflex that helps to clear the respiratory tract of mucus and irritants. Suppressing a productive cough can lead to the retention of secretions in the lungs, increasing the risk of secondary bacterial infections like pneumonia. Therefore, a cough that accompanies a cold should not be suppressed unless it is non-productive and interfering with rest or other essential activities.

Choice C rationale

While a child with a cold may pull their ear, this is more indicative of otitis media, or a middle ear infection, which can be a complication of a cold. It is not a characteristic of the cold itself. Pulling the ear is a symptom of pressure and pain in the middle ear caused by fluid accumulation, which is a different medical issue requiring a distinct diagnosis and management.

Choice D rationale

This statement is inaccurate. Young children, especially those in daycare or preschool, have immature immune systems and are frequently exposed to new viruses. Consequently, it is common and normal for healthy children to experience multiple colds per year, often six to eight or more, as they build immunity to various viral strains.