# Stage 4 — Generate solutions. Which interventions should the nurse anticipate for the current acute chest syndrome plan? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568855&lang=en  
> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

Stage 4 — Generate solutions. Which interventions should the nurse anticipate for the current acute chest syndrome plan? Select all that apply.

1Titrate prescribed oxygen and trend saturation continuously
2Administer the prescribed cephalosporin and macrolide
3Encourage incentive spirometry while awake
4Use cautious hydration and reassess lung findings and intake-output
5Coordinate hematology and blood-bank evaluation because hemoglobin has fallen below baseline
6Give repeated sedating opioid doses without respiratory reassessment
7Delay antimicrobial therapy until culture results are final
8Give a rapid large-volume fluid bolus despite worsening lung findings

## Explanation

Current management includes oxygen for hypoxemia, broad antimicrobial coverage, incentive spirometry, careful hydration, analgesia with respiratory surveillance, and transfusion evaluation when anemia and respiratory severity increase. Unmonitored sedation and delayed escalation are unsafe.

## In-depth explanation

Quick answer
Combine oxygen, antibiotics, spirometry, cautious fluid management, safe analgesia, and early transfusion evaluation.

Why this is correct
Acute chest syndrome requires simultaneous support of oxygenation, treatment of infection risk, prevention of atelectasis, and hematologic escalation when severity increases.

Easy analogy or mental picture
Use several small levers together rather than one oversized lever: oxygen, lung expansion, antimicrobials, balanced fluid, and blood support.

Memory hook
Open lungs, treat infection, avoid overload, call hematology.

NCLEX decision rule
Build a coordinated plan that treats the syndrome and limits treatment-related respiratory harm; never let pain control eliminate ventilation monitoring.

Why the other choices are wrong
Waiting for cultures delays indicated therapy, unmonitored opioid dosing risks hypoventilation, and indiscriminate fluid loading can worsen pulmonary status.

References
1Common Acute Complications of Sickle Cell DiseaseAcute chest syndrome recognition, antibiotics, oxygen, spirometry, monitoring, and escalation
2ASH Sickle Cell Disease Guidelines: Transfusion SupportSimple versus exchange transfusion considerations in moderate and severe acute chest syndrome

## Clinical scenario

Case update
The child is receiving oxygen. Hemoglobin is 1.5 g/dL below baseline and respiratory effort remains increased.

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