A nurse is caring for an adolescent who has sickle-cell anemia. Which of the following manifestations indicates acute chest syndrome and should be immediately reported to the provider?

Rationale:

A. "Tell me how you are feeling about your mom dying.": This encourages the daughter to express her emotions, which is an important first step in processing grief and finding the right words to support her mother. It shows empathy and opens a therapeutic conversation.

B. "You sound like you have questions about your mom dying. Let's talk about it.": This response invites the daughter to engage in a meaningful discussion about her concerns. It provides emotional support and creates a safe space for her to ask questions and gain clarity.

C. "Let's talk about your mom's cancer and how things will progress from here.": Educating the daughter about the disease process and what to expect during hospice care can reduce anxiety and help her feel more prepared to have honest conversations with her mother.

D. "Tell her not to worry. She still has plenty of time left.": This response offers false reassurance and avoids the reality of the situation. It can prevent the daughter from addressing important emotional or end-of-life discussions with her mother.

E. "Hospice will take good care of your mom, so I wouldn't worry about that.": Although hospice provides excellent care, this response shifts the focus away from the daughter’s emotional needs and discourages open communication about death and dying.

Rationale:

A. Establish a patent oral airway: The airway is the highest priority in trauma care, following the ABCs (Airway, Breathing, Circulation). Without a patent airway, the client cannot oxygenate properly, which can quickly become life-threatening.

B. Remove the client's clothing: This helps with full-body assessment and prevention of missed injuries, but it should only be done after ensuring the client’s airway and breathing are stable.

C. Warm blood products prior to administration: While this helps prevent hypothermia during transfusion, warming blood is not the immediate priority in a trauma situation. Circulation support follows airway and breathing in priority.

D. Assign the client a score on the Glasgow Coma Scale: Neurological assessment is important but comes after airway stabilization. The GCS helps evaluate consciousness but should not delay securing the airway in an emergency.