COMPREHENSIVE PROFESSIONAL NURSING
EXAMINATION
Pediatric Hematology: Management & Nursing Care in Sickle Cell
Anemia Vaso-Occlusive Crisis (200 Questions with Detailed Rationales)
MODULE 1: Emergency Prioritization & Triage (Questions 1-35)
Question 1: [1] A nurse is caring for a school-age child who has
sickle cell anemia (SCA) and is admitted in a vaso-occlusive crisis
(VOC). Which of the following nursing interventions is the absolute
priority upon arrival?
A. Administering scheduled prophylactic oral penicillin V potassium.
B. Applying warm compresses to the painful extremity joints.
C. Initiating IV fluid hydration with hypotonic dextrose 5% in water.
D. Assessing respiratory status, oxygen saturation, and administering
supplemental oxygen if saturation is < 92%.
Correct Answer: D — Rationale: (Question 1 Rationale): Using the
ABCDE and urgent prioritization framework, oxygenation and
respiratory status are always the top priority in any vaso-occlusive
crisis to prevent hypoxemia, which further exacerbates sickling.
While pain management and hydration are critical, airway and
breathing take absolute precedence. In clinical practice and
professional examinations, prioritizing ABCs, monitoring for acute
complications (ACS, stroke, sequestration, sepsis), and patient/family
education form the core pillars of pediatric hematology nursing.
Question 2: [2] An 8-year-old child with sickle cell disease presents
with severe vaso-occlusive crisis pain in the lower back and
,extremities. The pulse oximetry reading drops to 89% on room air.
What is the nurse's immediate priority action?
A. Administer morphine sulfate via patient-controlled analgesia
(PCA).
B. Initiate supplemental oxygen therapy to maintain oxygen
saturation ≥ 92%-95%.
C. Draw an urgent type and crossmatch for a packed red blood cell
transfusion.
D. Encourage oral intake of at least 250 mL of clear fluids per hour.
Correct Answer: B — Rationale: (Question 2 Rationale): Hypoxia
is a primary trigger for red blood cell sickling. When SpO2 drops
below normal parameters (typically < 92%), administering
supplemental oxygen is the immediate priority to reverse hypoxemia
and halt further polymerization of hemoglobin S. In clinical practice
and professional examinations, prioritizing ABCs, monitoring for
acute complications (ACS, stroke, sequestration, sepsis), and
patient/family education form the core pillars of pediatric hematology
nursing.
,Question 3: [3] A nurse is planning care for a school-age child
experiencing a severe sickle cell vaso-occlusive crisis. Which IV fluid
order should the nurse question or verify with the primary
healthcare provider?
A. 0.9% Sodium Chloride with 5% Dextrose at 1.5 times
maintenance.
B. Lactated Ringer's solution at 150 mL/hr.
C. 0.45% Sodium Chloride with 5% Dextrose at maintenance rate.
D. 5% Dextrose in Water (D5W) infusing at 100 mL/hr.
Correct Answer: C — Rationale: (Question 3 Rationale):
Hypotonic fluids such as 0.45% Sodium Chloride or D5W can cause
RBC swelling or fail to provide adequate intravascular expansion
necessary to decrease blood viscosity during a VOC. Isotonic
crystalloids (e.g., D5W with 0.9% NaCl or LR) at 1.5 to 2 times
maintenance are standard to promote hydration and hemodilution. In
clinical practice and professional examinations, prioritizing ABCs,
monitoring for acute complications (ACS, stroke, sequestration,
sepsis), and patient/family education form the core pillars of pediatric
hematology nursing.
, Question 4: [4] A child in vaso-occlusive crisis is receiving IV
morphine via PCA pump. The child's parents express concern that
their child is becoming addicted to the narcotic. What is the nurse's
best response?
A. 'Addiction is common in children with sickle cell disease, so we
limit opioid use strictly to every 6 hours.'
B. 'Physical dependence and true addiction are different; effective
pain control during a crisis prevents chronic pain behaviors and
severe complications.'
C. 'We will switch the patient immediately to non-steroidal anti-
inflammatory drugs (NSAIDs) to avoid addiction.'
D. 'Do not worry, children cannot become addicted to opioids while
hospitalized.'
Correct Answer: B — Rationale: (Question 4 Rationale): Tolerance
and physical dependence are normal physiological responses to
chronic or acute opioid administration, distinct from psychological
addiction. Undermedicating sickle cell pain due to fear of addiction is
a major barrier to effective care. In clinical practice and professional
examinations, prioritizing ABCs, monitoring for acute complications
(ACS, stroke, sequestration, sepsis), and patient/family education
form the core pillars of pediatric hematology nursing.
EXAMINATION
Pediatric Hematology: Management & Nursing Care in Sickle Cell
Anemia Vaso-Occlusive Crisis (200 Questions with Detailed Rationales)
MODULE 1: Emergency Prioritization & Triage (Questions 1-35)
Question 1: [1] A nurse is caring for a school-age child who has
sickle cell anemia (SCA) and is admitted in a vaso-occlusive crisis
(VOC). Which of the following nursing interventions is the absolute
priority upon arrival?
A. Administering scheduled prophylactic oral penicillin V potassium.
B. Applying warm compresses to the painful extremity joints.
C. Initiating IV fluid hydration with hypotonic dextrose 5% in water.
D. Assessing respiratory status, oxygen saturation, and administering
supplemental oxygen if saturation is < 92%.
Correct Answer: D — Rationale: (Question 1 Rationale): Using the
ABCDE and urgent prioritization framework, oxygenation and
respiratory status are always the top priority in any vaso-occlusive
crisis to prevent hypoxemia, which further exacerbates sickling.
While pain management and hydration are critical, airway and
breathing take absolute precedence. In clinical practice and
professional examinations, prioritizing ABCs, monitoring for acute
complications (ACS, stroke, sequestration, sepsis), and patient/family
education form the core pillars of pediatric hematology nursing.
Question 2: [2] An 8-year-old child with sickle cell disease presents
with severe vaso-occlusive crisis pain in the lower back and
,extremities. The pulse oximetry reading drops to 89% on room air.
What is the nurse's immediate priority action?
A. Administer morphine sulfate via patient-controlled analgesia
(PCA).
B. Initiate supplemental oxygen therapy to maintain oxygen
saturation ≥ 92%-95%.
C. Draw an urgent type and crossmatch for a packed red blood cell
transfusion.
D. Encourage oral intake of at least 250 mL of clear fluids per hour.
Correct Answer: B — Rationale: (Question 2 Rationale): Hypoxia
is a primary trigger for red blood cell sickling. When SpO2 drops
below normal parameters (typically < 92%), administering
supplemental oxygen is the immediate priority to reverse hypoxemia
and halt further polymerization of hemoglobin S. In clinical practice
and professional examinations, prioritizing ABCs, monitoring for
acute complications (ACS, stroke, sequestration, sepsis), and
patient/family education form the core pillars of pediatric hematology
nursing.
,Question 3: [3] A nurse is planning care for a school-age child
experiencing a severe sickle cell vaso-occlusive crisis. Which IV fluid
order should the nurse question or verify with the primary
healthcare provider?
A. 0.9% Sodium Chloride with 5% Dextrose at 1.5 times
maintenance.
B. Lactated Ringer's solution at 150 mL/hr.
C. 0.45% Sodium Chloride with 5% Dextrose at maintenance rate.
D. 5% Dextrose in Water (D5W) infusing at 100 mL/hr.
Correct Answer: C — Rationale: (Question 3 Rationale):
Hypotonic fluids such as 0.45% Sodium Chloride or D5W can cause
RBC swelling or fail to provide adequate intravascular expansion
necessary to decrease blood viscosity during a VOC. Isotonic
crystalloids (e.g., D5W with 0.9% NaCl or LR) at 1.5 to 2 times
maintenance are standard to promote hydration and hemodilution. In
clinical practice and professional examinations, prioritizing ABCs,
monitoring for acute complications (ACS, stroke, sequestration,
sepsis), and patient/family education form the core pillars of pediatric
hematology nursing.
, Question 4: [4] A child in vaso-occlusive crisis is receiving IV
morphine via PCA pump. The child's parents express concern that
their child is becoming addicted to the narcotic. What is the nurse's
best response?
A. 'Addiction is common in children with sickle cell disease, so we
limit opioid use strictly to every 6 hours.'
B. 'Physical dependence and true addiction are different; effective
pain control during a crisis prevents chronic pain behaviors and
severe complications.'
C. 'We will switch the patient immediately to non-steroidal anti-
inflammatory drugs (NSAIDs) to avoid addiction.'
D. 'Do not worry, children cannot become addicted to opioids while
hospitalized.'
Correct Answer: B — Rationale: (Question 4 Rationale): Tolerance
and physical dependence are normal physiological responses to
chronic or acute opioid administration, distinct from psychological
addiction. Undermedicating sickle cell pain due to fear of addiction is
a major barrier to effective care. In clinical practice and professional
examinations, prioritizing ABCs, monitoring for acute complications
(ACS, stroke, sequestration, sepsis), and patient/family education
form the core pillars of pediatric hematology nursing.
