To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

Administer an iron supplement daily.

Encourage the child to participate in school activities such as long-distance running.

Prevent the child from drinking an excessive amount of fluids per day.

Notify a health care provider if the child develops an upper respiratory infection.

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is A

Explanation

A macrosomic infant, weighing over 4000 grams (8 lbs 13 oz), significantly stretches the uterine muscles, leading to a diminished ability to contract effectively after birth. This uterine atony is the primary cause of postpartum hemorrhage. The uterus fails to clamp down on the blood vessels at the placental site, resulting in continuous bleeding. The client’s G6 status further increases this risk due to repeated uterine stretching.

Choice B rationale

Thrombosis is a risk in the postpartum period due to hypercoagulability and venous stasis, but it is not the primary complication associated with a macrosomic infant and high parity. The most immediate and significant risk following this type of delivery is the uterus's inability to contract properly, leading to uncontrolled bleeding. While thrombosis is a concern, it is a secondary risk compared to hemorrhage.

Choice C rationale

Postpartum seizures, also known as eclampsia, are typically associated with preeclampsia and hypertension, not specifically with macrosomic infants or high parity. While a client may have other risk factors for seizures, a large infant and multiparity do not directly cause them. The primary and most immediate physiological risk is the inability of the uterus to involute and stop bleeding.

Choice D rationale

While infection is a risk following any delivery, especially if there are lacerations or a prolonged rupture of membranes, it is not the immediate or most significant complication related to a macrosomic infant. The overwhelming primary concern in this specific scenario is the uterine atony caused by the large infant and multiple pregnancies, which predisposes the client to hemorrhage.

A. The nasal discharge is increasing. B. The cough is becoming harsher. C. The respiratory rate is gradually increasing. D. The toddler states being tired and wanting to sleep.

Correct Answer is D

Explanation

Choice A rationale

Increasing nasal discharge is a common symptom of upper respiratory tract infections and does not specifically indicate a progression to airway occlusion in croup. While it contributes to overall respiratory distress, it is not the most critical sign of a life-threatening compromise of the airway in this condition.

Choice B rationale

A harsher cough, often described as a "barking" cough, is a characteristic symptom of croup caused by inflammation of the larynx, trachea, and bronchi. While concerning, it is not the most reliable indicator of impending airway occlusion. The cough may be present throughout the illness without a complete occlusion.

Choice C rationale

An increasing respiratory rate is an early compensatory mechanism in response to airway obstruction and hypoxia. While it indicates respiratory distress, it is not the most significant sign of impending airway occlusion. It can occur with many respiratory issues and is often a precursor to more severe signs.

Choice D rationale

A toddler stating they are tired and wanting to sleep is a serious and late sign of hypoxia. This indicates that the child is becoming fatigued from the increased work of breathing, leading to decreased respiratory effort. This mental status change signals that the body's compensatory mechanisms are failing, and respiratory failure and airway occlusion are imminent.

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To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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