The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child’s diagnosis?
Slightly yellow sclera.
Depigmented areas on the abdomen.
Enlarged mandibular growth.
Increased growth of long bones.
The Correct Answer is A
Choice A rationale
Slightly yellow sclera, or jaundice, is a common finding in children with sickle cell anemia. The breakdown of sickled red blood cells leads to increased bilirubin levels in the blood, which can cause jaundice. This yellowing is often most noticeable in the sclera of the eyes. Jaundice is a result of hemolysis, a hallmark of sickle cell anemia, where red blood cells are destroyed faster than they can be produced.
Choice B rationale
Depigmented areas on the abdomen are not typically associated with sickle cell anemia. Sickle cell anemia primarily affects the blood and organs, leading to complications such as pain crises, anemia, and organ damage. Skin changes like depigmentation are not characteristic of this condition and may indicate other underlying issues.
Choice C rationale
Enlarged mandibular growth is not a common finding in sickle cell anemia. While children with sickle cell anemia may experience growth delays and skeletal abnormalities due to chronic anemia and bone marrow hyperactivity, mandibular enlargement is not a typical feature. Skeletal changes in sickle cell anemia are more likely to involve long bones and vertebrae.
Choice D rationale
Increased growth of long bones is not a characteristic finding in sickle cell anemia. In fact, children with sickle cell anemia may experience growth delays and shorter stature due to chronic anemia and the body’s increased demand for red blood cell production. The condition can lead to skeletal abnormalities, but these typically involve bone infarctions and deformities rather than increased growth.
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Correct Answer is C
Explanation
Choice A rationale
Varying the child’s schedule each day can create a sense of unpredictability and insecurity. According to Erikson’s theory of psychosocial development, children in this age group (10 years old) are in the stage of industry versus inferiority. They need a sense of routine and structure to develop a sense of competence and accomplishment. A consistent schedule helps them feel secure and focused on their tasks.
Choice B rationale
Providing a daily session with a play therapist can be beneficial for the child’s emotional well- being. However, it does not directly address the child’s need for a sense of competence and accomplishment. According to Erikson’s theory, children in this age group need to develop a sense of industry by mastering tasks and completing school work.
Choice C rationale
Encouraging the client to complete school work helps promote a sense of industry and competence. According to Erikson’s theory, children in this age group need to develop a sense of accomplishment through mastering tasks. Completing school work provides them with a sense of purpose and achievement, which is essential for their psychosocial development.
Choice D rationale
Discouraging visits from the client’s friends can lead to feelings of isolation and loneliness. According to Erikson’s theory, social interactions and relationships are important for the child’s psychosocial development. Encouraging visits from friends can help the child feel connected and supported during their hospitalization.
Correct Answer is C
Explanation
Choice A rationale
Coughing and shortness of breath in the morning are signs of poor asthma control, not well- controlled asthma. These symptoms indicate that the child’s asthma is not being managed effectively and may require adjustments in their treatment plan.
Choice B rationale
This statement is incorrect. If asthma is not controlled, the child is likely to miss more days of school due to asthma symptoms and exacerbations. Effective asthma management aims to reduce symptoms and prevent asthma attacks, allowing the child to attend school regularly.
Choice C rationale
Eliminating allergens that irritate the lungs is a key strategy in preventing asthma attacks. Allergens such as dust mites, pet dander, mold, and pollen can trigger asthma symptoms. By reducing exposure to these allergens, the child can better manage their asthma and reduce the frequency of attacks.
Choice D rationale
This statement is false. Children with well-controlled asthma can participate in sports and physical activities. Physical activity is beneficial for lung function and overall health. The nurse should teach the child how to prevent exercise-induced asthma symptoms, such as using a bronchodilator before exercise.