The nurse is conducting an admission assessment of an infant with heart failure who is scheduled for repair of restenosis of coarctation of the aorta that was repaired 4 days after birth. Findings include blood pressure higher in the arms than the lower extremities, pounding brachial pulses, and slightly palpable femoral pulses. Which pathophysiologic mechanism supports these findings?

Choice A reason: Applying a cool pack to the injection site is a simple and effective way to reduce discomfort after receiving the varicella vaccine. The cool pack can help numb the pain, decrease swelling, and prevent bruising. The nurse should instruct the parent to apply the cool pack for 10 to 15 minutes at a time, several times a day, as needed.

Choice B reason: Any level of fever is not serious and does not need to be reported right away. Fever is a common side effect of the varicella vaccine and usually lasts for 1 to 2 days. Fever is a sign that the body is developing immunity against the chickenpox virus. The nurse should instruct the parent to monitor the child's temperature and give them acetaminophen or ibuprofen to lower the fever, if necessary. The nurse should also advise the parent to call the health care provider if the fever is higher than 102°F (38.9°C) or lasts longer than 3 days.

Choice C reason: Chewable children's aspirin will not help prevent inflammation and may cause serious harm. Aspirin is not recommended for children under 18 years of age who have viral infections, such as chickenpox, because it can increase the risk of Reye's syndrome, a rare but potentially fatal condition that affects the brain and liver. The nurse should instruct the parent to avoid giving the child aspirin or any products that contain aspirin, such as bismuth subsalicylate.

Choice D reason: Keeping the child home from daycare for the next two days is not necessary and may be inconvenient. The varicella vaccine is very effective at preventing chickenpox and does not pose a risk of spreading the virus to others. The nurse should instruct the parent to resume the child's normal activities, unless they have other symptoms that warrant staying home, such as rash, vomiting, or diarrhea.

Choice A reason: Enabling limited time for cell phone use is not the best intervention that the nurse can implement to support the client's psychosocial needs. While cell phone use can help the client stay connected with their peers and social media, it can also be a source of distraction and stress. The nurse should encourage the client to balance their cell phone use with other activities that promote their well-being.

Choice B reason: Providing an activity room to spend time with other adolescents is the best intervention that the nurse can implement to support the client's psychosocial needs. This intervention can help the client cope with the anxiety and isolation that may result from their condition and hospitalization. It can also provide an opportunity for the client to interact with other adolescents who have similar experiences and challenges, and to engage in fun and meaningful activities that enhance their self-esteem and mood.

Choice C reason: Delivering 3 meals and snacks each day upon request is not the best intervention that the nurse can implement to support the client's psychosocial needs. While it is important to maintain the client's nutrition and hydration, it is not enough to address their emotional and social needs. The nurse should also encourage the client to eat with other adolescents or family members when possible, and to express their preferences and concerns about their food.

Choice D reason: Allowing family and friends to be present during assessments is not the best intervention that the nurse can implement to support the client's psychosocial needs. While it is important to involve the client's family and friends in their care, it is not necessary to have them present during every assessment. The nurse should respect the client's privacy and autonomy, and ask for their consent before allowing others to observe or participate in their assessments. The nurse should also provide the client with opportunities to talk to their family and friends in a comfortable and confidential setting.