A nurse is caring for a child who has red marks across his cheeks. Which of the following actions should the nurse take?

Choice A reason: Discouraging a high level of fluid intake is incorrect, as hydration is essential for preventing sickle cell crises and reducing blood viscosity. The nurse should encourage the child to drink at least 1.5 times the normal fluid requirement.

Choice B reason: Administering meperidine every 4 hr for pain is incorrect, as meperidine is not recommended for sickle cell pain due to the risk of neurotoxicity and seizures. The nurse should use other opioids such as morphine or hydromorphone for pain management.

Choice C reason: Applying cold compresses to painful, swollen joints is incorrect, as cold can cause vasoconstriction and worsen the sickling of red blood cells. The nurse should use warm compresses or heating pads to promote vasodilation and blood flow.

Choice D reason: Observing for indications of hypokalemia is correct, as sickle cell anemia can cause hemolysis and potassium loss. The nurse should monitor the child's serum potassium level and watch for signs of hypokalemia such as muscle weakness, cramps, arrhythmias, and constipation.

Choice A reason: Intravenous immunoglobulin is a likely prescription, as it is used to treat Kawasaki disease, which is a rare but serious condition that causes inflammation of the blood vessels in children. The toddler has many signs and symptoms of Kawasaki disease, such as high fever, irritability, red eyes, dry lips, strawberry tongue, swollen hands and feet, rash, and enlarged lymph node. Intravenous immunoglobulin can reduce the risk of complications, such as coronary artery aneurysms, which can be life-threatening.

Choice B reason: Oral acyclovir is not a probable prescription, as it is used to treat viral infections, such as herpes simplex or varicella zoster, which are not the main problems of the toddler. The toddler has no evidence of a viral infection, such as blisters, vesicles, or crusts.

Choice C reason: Intramuscular penicillin is not a likely prescription, as it is used to treat bacterial infections, such as streptococcal pharyngitis or syphilis, which are not the main problems of the toddler. The toddler has no signs of a bacterial infection, such as purulent discharge, foul odor, or localized inflammation.

Choice D reason: Topical hydrocortisone is not a helpful prescription, as it is used to treat skin conditions, such as eczema or dermatitis, which are not the main problems of the toddler. The toddler has a rash that is caused by the inflammation of the blood vessels, not by an allergic or irritant reaction. Topical hydrocortisone may also worsen the rash or cause skin thinning or infection.