Stage 4 — Generate solutions. The 3-year-old child (14 kg) is on day 6 of fever. The echocardiogram shows a left anterior descending coronary artery Z-score of 2.7, other coronary Z-scores below 2, and normal ventricular function. Platelets are 522,000/mm3. IVIG 2 g/kg and aspirin are prescribed. Which interventions should the nurse anticipate in the current plan? Select all that apply.

Quick answer
Anticipate the single IVIG infusion with vital signs, aspirin every 6 hours with bleeding surveillance, repeat echocardiography within 1 to 2 weeks, and reporting fever at least 36 hours after IVIG (1, 5, 6, 7).

Why this is correct
Standard initial therapy is IVIG 2 g/kg as a single infusion plus moderate- or high-dose aspirin. Because an LAD Z-score of 2.7 is already abnormal, early and repeated echocardiography tracks progression. Fever of 38.0 C or more that persists or returns at least 36 hours after completion of IVIG defines IVIG resistance and requires prompt reporting because it predicts coronary progression.

Easy analogy or mental picture
Treat the fire with IVIG and aspirin, then keep checking the wiring (the coronaries) and watch for smoke returning (fever after 36 hours).

Memory hook
Z-score ladder: under 2 normal, 2 to under 2.5 dilation, 2.5 to under 5 small, 5 to under 10 medium, 10 or more large (anticoagulate).

NCLEX decision rule
Let the numeric data choose the intensity of therapy: match anticoagulation to aneurysm size, aspirin dose changes to fever status, and fever reporting to the defined time after IVIG.

Why the other choices are wrong
Early low-dose aspirin is tempting because low-dose aspirin is the long-term plan, but the switch occurs after the child has been afebrile for 48 to 72 hours, not when the infusion ends. Warfarin is tempting because an aneurysm is present, but systemic anticoagulation is reserved for large or giant aneurysms, not a Z-score of 2.7. Influenza vaccination is appropriate, but the live nasal spray is contraindicated in children receiving aspirin because of Reye syndrome risk; the inactivated injection is used. Corticosteroids may be considered with IVIG in high-risk children, but substituting them for IVIG is not standard therapy.