A 12-year-old child with sickle cell disease is admitted with a vaso-occlusive crisis. The child rates pain as 10/10 but refuses IV opioids due to fear of needles. Which intervention should the nurse implement FIRST?
Document the refusal and delay analgesia.
Explain that pain medication is mandatory.
Ask the child to wait until the pain becomes severe.
Offer nonpharmacologic pain.
The Correct Answer is D
A. Delaying pain management is not appropriate in a child experiencing a vaso-occlusive crisis. Pain relief is a priority nursing intervention, and documenting refusal without offering alternatives does not address the child’s suffering.
B. Forcing medication or implying it is mandatory can increase the child’s fear and anxiety, potentially worsening pain and reducing cooperation. It is not a therapeutic approach and does not respect the child’s autonomy.
C. Waiting is unsafe and unethical. A pain score of 10/10 indicates severe pain that requires prompt management. Delaying treatment can increase the risk of pain-related complications, including stress-induced vaso-occlusion or prolonged crisis.
D. Since the child refuses IV opioids due to fear of needles, the nurse should first implement alternative strategies while respecting the child’s autonomy. Nonpharmacologic interventions for sickle cell pain include distraction techniques such as videos, games, or music, guided imagery or relaxation exercises, heat application to affected joints, and deep breathing exercises. These approaches can reduce anxiety and pain perception and can be used immediately while exploring other analgesic options, such as oral opioids, patient-controlled analgesia, or topical analgesics.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Feeling hot when the room is cold is not a typical sign or complication of severe preeclampsia. This symptom is more related to general temperature sensitivity and does not indicate the hematologic or vascular complications associated with preeclampsia.
B. Evidence of bleeding, including gums bleeding, petechiae, and purpura, may indicate thrombocytopenia or a progression toward HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), a severe complication of preeclampsia. These findings suggest impaired coagulation and increased risk of bleeding, which are life-threatening if not promptly managed. Monitoring for such hematologic complications is essential in severe preeclampsia.
C. Edema of the lower extremities is common in normal pregnancy and mild preeclampsia, but it is not a specific sign of a serious complication. While generalized edema can indicate worsening preeclampsia, isolated lower-extremity edema is not as closely associated with life-threatening complications as bleeding or hematologic abnormalities.
D. Periods of fetal movement followed by quiet periods are typical fetal behavior and do not indicate a maternal complication of preeclampsia. Monitoring for changes in fetal movement is important, but this finding alone does not reflect maternal complications of severe preeclampsia.
Correct Answer is B
Explanation
A. Directional trends describe the general patterns of growth, such as cephalocaudal (head-to-toe) or proximodistal (center-to-periphery) development. The scenario focuses on differences in the rate of skill acquisition, not the direction of development.
B. Developmental pace refers to the rate at which different skills or abilities emerge, which can vary among domains. In this scenario, the toddler’s language skills are advancing rapidly, while gross motor skills like running show little change, illustrating that different areas of development progress at different rates.
C. Sensitive periods refer to specific windows of time during which a child is particularly responsive to certain types of learning or stimuli, such as language acquisition. The scenario does not specify a critical timing for development, but rather differences in progression across skills, so sensitive periods are not the primary principle illustrated.
D. Sequential trends refer to the orderly and predictable progression of developmental milestones, such as crawling before walking. While the toddler is developing language, the scenario emphasizes rate differences, not the order in which skills emerge.
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