A nurse is assessing a client who has asthma.
Which of the following areas should the nurse evaluate as the most reliable indicator of central cyanosis?

The correct answer is Choice 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.

The correct answer is Choice B.

Choice A rationale

Insulin should be administered subcutaneously, not intramuscularly. Rotating sites is important to prevent lipodystrophy, but the correct technique involves subcutaneous injection.

Choice B rationale

Drawing up the short-acting insulin into the syringe first is correct. This prevents contamination of the short-acting insulin vial with long-acting insulin, ensuring accurate dosing.

Choice C rationale

Wiping off the needle with an alcohol swab is not recommended. The needle should remain sterile, and only the top of the insulin vial should be wiped with an alcohol swab.

Choice D rationale

Administering insulin at a 30-degree angle is incorrect. Insulin should be administered at a 90- degree angle if the person can grasp 2 inches of skin, or at a 45-degree angle if only 1 inch of skin can be grasped.