The clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions?

Correct Answer: C

Rationale: The correct answer is C: Fluid overload. In sickle cell disease, excess fluid can lead to increased blood viscosity and further sickling of red blood cells, potentially triggering a pain crisis. In contrast, infection, trauma, and stress are known triggers for pain crisis in sickle cell disease, but they do not necessarily indicate a need for further instructions as the mother may already be aware of these factors. Therefore, identifying fluid overload as a precipitating factor would require additional instructions to avoid exacerbating the child's condition.

Correct Answer: C

Rationale: The correct answer is C because staying with the patient and focusing on slow deep breathing for relaxation is the most effective response to address the patient's fear and anxiety before the bone marrow aspiration and biopsy. Deep breathing techniques can help the patient calm down, reduce anxiety, and promote relaxation, making the procedure more manageable. This response also shows empathy and support, which can enhance the patient's emotional well-being. The other choices are incorrect because: A: Warning the patient to stay very still may increase her anxiety and fear, leading to more discomfort during the procedure. B: While having family present can provide support, it may not directly address the patient's fear and anxiety or help her relax. D: Delaying the procedure may prolong the patient's distress and uncertainty, whereas addressing the fear and anxiety promptly is crucial for the patient's well-being.

Correct Answer: B

Rationale: The correct answer is B: Platelet (thrombocyte) count. Platelet count typically remains relatively stable with age, so a decreased value in a 76-year-old client would be concerning. Hemoglobin (Hgb) level can decrease with age due to factors like nutritional deficiencies. Red blood cell (RBC) count tends to decrease with age as well. White blood cell (WBC) response can vary with age and immune system activity. Therefore, the decreased platelet count is the most concerning as it is not typically age-related, making it the correct answer.

Correct Answer: B

Rationale: The correct answer is B because the number of red blood cells varies with gender, age, and general health. This response is accurate as it acknowledges the variability in red blood cell counts among individuals. Choice A is incorrect as it provides a definitive answer without considering the factors influencing red blood cell count. Choice C is incorrect because it gives a blanket statement that all people have the same number of red blood cells, which is not true. Choice D is incorrect as it incorrectly links anemia directly to the number of red blood cells without considering the broader context of red blood cell variability.

Correct Answer: B

Rationale: The correct answer is B: No neurological symptoms in folic acid. Vitamin B12 and folic acid deficiencies both can lead to megaloblastic anemia and similar hematological symptoms. However, vitamin B12 deficiency can also cause neurological symptoms due to its role in nerve function, which folic acid deficiency does not. Glossitis (choice A) can be a symptom of both deficiencies. Muscle wasting (choice C) is not a common symptom of either deficiency. Dizziness (choice D) is a nonspecific symptom and can occur with various vitamin deficiencies, not specific to vitamin B12 or folic acid.