A nurse in a clinic is assessing a 7-month-old infant. Which of the following indicates a need for further evaluation?

Choice A: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to relieve pain and inflammation in children with influenza. Ibuprofen does not increase the risk of Reye syndrome, which is a rare but serious condition that affects the brain and liver.

Choice B: Grapefruit juice is a citrus fruit that can provide vitamin C and hydration for children with influenza. Grapefruit juice does not increase the risk of Reye syndrome, but it can interact with some medications and affect their absorption or metabolism.

Choice C: A humidifier is a device that adds moisture to the air and can help ease congestion and coughing in children with influenza. A humidifier does not increase the risk of Reye syndrome, but it should be cleaned regularly to prevent bacterial growth and infection.

Choice D: Aspirin is a salicylate that can be used to reduce fever and inflammation in children with influenza. However, aspirin can increase the risk of Reye syndrome, especially in children who have viral infections. Reye syndrome can cause swelling in the brain, liver damage, and even death. Therefore, aspirin should be avoided in children under 19 years old who have influenza or other viral illnesses.

Choice A: A 10-year-old child who has sickle cell anemia and reports severe chest pain should be assessed first, as this is a sign of acute chest syndrome, which is a life-threatening complication of sickle cell disease. Acute chest syndrome occurs when sickle-shaped red blood cells block the blood flow to the lungs, causing hypoxia, inflammation, and infection. Acute chest syndrome can lead to respiratory failure, pulmonary hypertension, or stroke.

Choice B: A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016 should be assessed second, as this is a sign of dehydration, which is a common complication of diabetes insipidus. Diabetes insipidus is a condition in which the body does not produce enough antidiuretic hormone (ADH) or does not respond to it properly, resulting in excessive urination and thirst. Dehydration can cause electrolyte imbalance, hypotension, or shock.

Choice C: A 4-year-old child who has asthma and an O2 sat of 97% should be assessed third, as this is a sign of adequate oxygenation, which is a desired outcome of asthma management. Asthma is a condition in which the airways become inflamed, narrow, and produce excess mucus, causing difficulty breathing, wheezing, coughing, or chest tightness. Asthma can be triggered by allergens, irritants, exercise, or infections.

Choice D: A 1-year-old toddler who has roseola and a temperature of 39°C/102.2°F should be assessed last, as this is a sign of a mild viral infection, which is self-limiting and usually resolves within a week. Roseola is a common childhood illness that causes a high fever followed by a pink rash on the trunk, face, and limbs. Roseola can also cause irritability, swollen lymph nodes, or mild diarrhea.