COMPLETE QUESTIONS AND SOLUTIONS
100% CORRECT
◍ A client hospitalized with sickle cell crisis frequently asks for
opioid pain medications, often shortly after receiving a dose. The
nurses on the unit believe the client is drug seeking. When the client
requests pain medication, what action by the nurse is best?
A. Give the client pain medication if it is time for another dose.
B. Instruct the client not to request pain medication too early.
C. Request the provider to leave a prescription for a placebo
D. Tell the client it is too early to have more pain medication. Answer:
A. Give the client pain medication it it is time for another dose.
Clients with sickle cell crisis often have severe pain that is managed
with up to 48 hours of IV opioid analgesics. Even if the client is
addicted and drug seeking, he or she is still in extreme pain. If the
client can receive another doe of medication, the nurse should provide
it, The other options are judgmental and do not address the client's
pain. Giving placebos is unethical.
◍ A client in sickle cell crisis is dehydrated and in the emergency
department. The nurse plans to start an IV. Which fluid choice is best?
A. 0.45% normal saline
B. 0.9% normal saline
,C. Dextrose 50% (D50)
D. Lactated Ringers solution. Answer: A. 0.45% normal saline
Because clients in sickle cell crisis are often dehydrated, the fluid of
choice is a hypotonic solution such as 0.45% normal saline. ).9%
normal saline and lactated ringers solution are isotonic. D50 is
hypertonic and not used for hydration.
◍ A client presents to the emergency department in sickle cell crisis.
What intervention by the nurse takes priority?
A. Administer oxygen
B. Apply an oximetry probe
C. Give pain medication
D. Start an IV line. Answer: A. Administer oxygen
All actions are appropriate, but remembering the ABCs, oxygen
would come first. The main problem in a sickle cell crisis is tissue and
organ hypoxia, so providing oxygen helps halt the process.
◍ A client has a sickle cell crisis with extreme lower extremity pain.
What comfort measure does the nurse delegate to the UAP?
A. Apply ice packs to the client's legs
B. Elevate the clients legs on pillows
C. Keep the lower extremities warms.
D. Place elastic bandage wraps on the client's legs.. Answer: C. Keep
the lower extremities warm
,During a sickle cell crisis, the tissue distal to the occlusion has
decreased blood flow and ischemia, leading to pain. Due to decreased
blood flow, the clients legs will be cool or cold. The UAP can attempt
to keep the clients legs warm. Ice and elevation will further decrease
perfusion. Elastic bandage wraps are not indicated and may constrict
perfusion in the legs
◍ A client admitted for sickle cell crisis is distraught after learning
her child also has the disease. What response by the nurse is best?
A. Both you and the father are equally responsible for passing it on.
B. I can see you are upset. I can stay here with you awhile if you like
C. It's not your fault; there is no way to know who will have this
disease
D. There are many good treatments for sickle cell disease these days..
Answer: B. I can see you are upset. I can stay here with you awhile if
you like.
The best response is for the nurse to offer self, a therapeutic
communication technique that uses presence. Attempting to assign
blame to both parents will not help the client feel better. There is
genetic testing available, so it is inaccurate to state there is no way to
know who will have the disease. Stating that good treatments exist
belittles the client's feelings.
◍ A client with sickle cell disease (SCD) takes hydroxyurea (Droxia).
The client presents to the clinic reporting an increase in fatigue. What
laboratory result should the nurse report immediately?
, A. Hematocrit: 25%
B. Hemoglobin: 9.2
C. Potassium: 3.2
D. WBC: 38,000. Answer: D. WBC: 38,000
Although individuals with SCD often have elevated WBC counts, this
extreme elevation could indicate leukemia, a complication of taking
hydoxyurea. The nurse should report this finding immediately.
Alternatively, it could indicate infection, a serious problem for clients
with SCD. Hematocrit and hemoglobin levels are normally low in
people with SCD. The potassium level, while slightly low, is not
worrisome as the WBCs.
◍ A nurse working with clients with sickle cell disease teaches about
self-management to prevent exacerbations and sickle cell crisis. What
factors should clients be taught to avoid? (Select all that apply)
A. Dehydration
B. Exercise
C. Extreme stress
D. High altitudes
E. Pregnancy. Answer: A,C,D,E
Several factors cause RBCs to sickle in SCD, including dehydration,
extreme stress, high altitudes, and pregnancy. Strenuous exercise can
also cause sickling, but not unless it is very vigorous.