A 21-year-old patient with a known history of sickle cell anemia presents to the emergency department with severe pain in the lower back and joints, fatigue, and fever. What is the most likely cause of these symptoms?
Acute lymphoblastic leukemia
Iron-deficiency anemia
Vaso-occlusive crisis
Pneumonia
The Correct Answer is C
Choice A Reason:
Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the blood and bone marrow. While it can cause symptoms such as fatigue and fever, it is less likely to cause severe pain in the lower back and joints, which are more characteristic of a vaso-occlusive crisis in sickle cell anemia. ALL typically presents with symptoms like frequent infections, easy bruising or bleeding, and bone pain, but the combination of severe pain, fatigue, and fever in a patient with sickle cell anemia points more towards a vaso-occlusive crisis.
Choice B Reason:
Iron-deficiency anemia is a condition where there is a lack of adequate iron to form healthy red blood cells. Symptoms include fatigue, weakness, and pale skin, but it does not typically cause severe pain in the lower back and joints or fever. The presence of severe pain and fever in a patient with sickle cell anemia is more indicative of a vaso-occlusive crisis rather than iron-deficiency anemia.
Choice C Reason:
Vaso-occlusive crisis is a common and painful complication of sickle cell anemia. It occurs when sickled red blood cells block blood flow to parts of the body, causing severe pain, often in the back, joints, and abdomen. This condition can also lead to fever and fatigue due to the body’s inflammatory response and the reduced oxygen delivery to tissues. Given the patient’s history of sickle cell anemia and the described symptoms, a vaso-occlusive crisis is the most likely cause.
Choice D Reason:
Pneumonia is an infection that inflames the air sacs in one or both lungs, which can cause symptoms such as fever, chills, and difficulty breathing. While pneumonia can occur in patients with sickle cell anemia, it is less likely to cause severe pain in the lower back and joints. The combination of severe pain, fatigue, and fever in this patient is more consistent with a vaso-occlusive crisis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","F"]
Explanation
Choice A Reason:
Acetone breath is typically associated with diabetic ketoacidosis (DKA), not hyperosmolar hyperglycemic syndrome (HHS). DKA occurs when there is a significant production of ketones due to the breakdown of fat for energy, leading to a fruity or acetone-like smell on the breath. HHS, on the other hand, does not usually involve significant ketone production.
Choice B Reason:
Fever can be a manifestation of HHS, especially if there is an underlying infection or illness that has precipitated the hyperglycemic crisis. Infections are common triggers for HHS and can contribute to the severity of the condition.
Choice C Reason:
Older age is a risk factor for HHS. HHS is more commonly seen in older adults with type 2 diabetes, often those who have underlying chronic conditions or are experiencing acute illness. The patient’s age of 68 years supports the likelihood of HHS.
Choice D Reason:
A serum glucose level of 800 mg/dL is indicative of HHS. HHS is characterized by extremely high blood glucose levels, often exceeding 600 mg/dL, without significant ketone production. This high glucose level leads to severe dehydration and hyperosmolarity.
Choice E Reason:
A serum bicarbonate level of 15 mEq/L is more indicative of DKA rather than HHS. In HHS, serum bicarbonate levels are typically normal or only mildly decreased because there is no significant ketoacidosis. Therefore, this choice does not support the clinical presentation of HHS.
Choice F Reason:
An insidious onset is characteristic of HHS. Unlike DKA, which can develop rapidly, HHS often develops over days to weeks. Patients may experience gradually worsening symptoms such as increased thirst, frequent urination, and confusion before seeking medical attention.
Correct Answer is A
Explanation
Choice A Reason:
Administering intravenous fluids and pain management is the most appropriate initial intervention for a patient with sickle cell anemia presenting with severe pain, fever, and dehydration. Sickle cell crises often lead to severe pain due to vaso-occlusion, where sickled red blood cells block blood flow to various parts of the body. Intravenous fluids help to rehydrate the patient and reduce blood viscosity, which can alleviate the vaso-occlusive crisis. Pain management is crucial to provide relief and improve the patient’s comfort. This approach addresses the immediate symptoms and stabilizes the patient.
Choice B Reason:
Applying cold compresses to the painful areas is not recommended for patients with sickle cell anemia. Cold can cause vasoconstriction, which may worsen the vaso-occlusion and increase pain. Instead, warm compresses are often suggested to help dilate blood vessels and improve blood flow.
Choice C Reason:
Administering antibiotics immediately is not the primary intervention unless there is a clear indication of an infection. While fever can be a sign of infection, it can also occur due to the inflammatory response associated with a sickle cell crisis. The priority is to manage pain and dehydration first, and then evaluate the need for antibiotics based on clinical findings.
Choice D Reason:
Encouraging the patient to perform light exercise is not appropriate during an acute sickle cell crisis. Physical activity can increase oxygen demand and exacerbate the pain and vaso-occlusion. Rest and adequate hydration are more suitable to manage the crisis effectively.
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