# The nurse reviews serial data for a client with sickle cell disease. Which findings require immediate follow-up for possible acute chest syndrome? Highlight the findings that support this complication.

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

The nurse reviews serial data for a client with sickle cell disease. Which findings require immediate follow-up for possible acute chest syndrome? Highlight the findings that support this complication.

| Assessment time | Recorded finding |
| --- | --- |
| 0800 | Bilateral leg pain remains 6/10 after the prescribed analgesic. |
| 0930 | Temperature rises to 38.6 °C after being 37.1 °C on admission. |
| 1000 | Urine output remains 45 mL/hr with clear amber urine. |
| 1030 | The client reports new chest pain and a frequent cough. |
| 1100 | The abdomen remains soft with active bowel sounds. |
| 1130 | The client drinks 240 mL of water without nausea. |
| 1200 | A new lung infiltrate appears as oxygen saturation falls to 89%. |
| 1230 | The client reports the usual aching in both knees. |
| 1300 | A previously documented soft systolic murmur is unchanged. |

## Explanation

Follow up on fever, new chest pain with cough, and a new pulmonary infiltrate with declining oxygen saturation. Acute chest syndrome is a medical emergency that can resemble pneumonia and impair oxygenation.

## In-depth explanation

Quick answer
The concerning pattern is new fever, chest pain with cough, and a new lung infiltrate with falling oxygen saturation. In a client with sickle cell disease, these findings support possible acute chest syndrome and require urgent escalation.

Why this is correct
Acute chest syndrome is a life-threatening pulmonary complication of sickle cell disease. Fever, cough, chest pain, breathing difficulty, low oxygen, and a new infiltrate can occur together as lung injury and vascular obstruction impair oxygen delivery. The selected findings show a new pulmonary process rather than uncomplicated limb pain alone.[2]

Easy analogy or mental picture
Imagine sickled cells and inflammation creating a traffic jam in the lung's oxygen lanes. Fever and chest symptoms are warning signs, while a new infiltrate and falling saturation show that the jam is affecting gas exchange. The picture simplifies several possible triggers and does not identify the cause by itself.

Memory hook
Sickle cell plus new chest, fever, or oxygen change: treat the lungs as urgent.

NCLEX decision rule
When a client with sickle cell disease develops new respiratory symptoms or oxygen decline, prioritize acute chest syndrome even when pain is already expected from a vaso-occlusive episode. A new infiltrate strengthens the concern but care should not wait for every feature to worsen.

Why the other choices are wrong
Stable limb pain, adequate urine output, an unchanged abdominal assessment, tolerating fluids, and a familiar baseline murmur do not establish a new pulmonary complication. They remain relevant to care but do not carry the same immediate respiratory risk.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]CDC: Acute Chest SyndromeCenters for Disease Control and Prevention

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