A nurse in an emergency department is caring for a client who is in a sickle cell crisis. Which of the following actions should the nurse take?(Select all that apply.).

Administer oxygen.

Administer opioids.

Administer whole blood.

Elevate the head of the bed to 30°.

Keep the client NPO.

Answer and Explanation

Correct Answer : A,B,D

Choice A rationale:

The nurse should administer oxygen to the client experiencing a sickle cell crisis. Sickle cell crisis can cause vaso-occlusion, leading to tissue hypoxia and pain. Administering oxygen helps to improve tissue oxygenation and relieve symptoms.

Choice B rationale:

Administering opioids is appropriate for managing the severe pain associated with a sickle cell crisis. Opioids are effective analgesics that can help alleviate the acute pain experienced by the client.

Choice C rationale:

Administering whole blood is not typically indicated for a sickle cell crisis. Whole blood transfusion is reserved for specific indications, such as severe anemia or acute blood loss, but it is not a standard treatment for sickle cell crisis pain.

Choice D rationale:

Elevating the head of the bed to 30° can improve oxygenation and reduce the workload on the respiratory system, which is beneficial for clients experiencing a sickle cell crisis. It helps to optimize lung expansion and alleviate hypoxia.

Choice E rationale:

Keeping the client NPO (nothing by mouth) is not necessary in a sickle cell crisis. There is no indication that the client cannot tolerate oral intake, so allowing them to eat and drink as usual is appropriate.

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Correct Answer is A

Explanation

Dispose of the client's feces and urine in a special container.

Choice A rationale:

This is the correct choice. Brachytherapy involves the placement of a radiation source in or near the tumor. To minimize radiation exposure to others, the client's bodily fluids (feces and urine) should be considered radioactive and disposed of properly in a designated container.

Choice B rationale:

While limiting the time of visitors can be a good measure to reduce radiation exposure, it is not the priority intervention. The primary concern is proper handling and disposal of radioactive bodily fluids.

Choice C rationale:

Keeping the client's linens in the room until after removal of the radiation source is not the correct choice. Radioactive linens should be handled and laundered separately, following appropriate safety protocols.

Choice D rationale:

Providing one dosimeter badge for staff to share while caring for the client is not adequate. Each staff member involved in direct care should have their dosimeter badge to monitor their individual radiation exposure levels.

A. A client who is newly diagnosed with type 1 diabetes mellitus and cannot afford insulin. B. A client who has Meniere's disease and cannot safely ambulate due to vertigo. C. A client who had a stroke and cannot eat or drink without choking. D. A client whose medications to manage Parkinson's disease are no longer effective.

Correct Answer is D

Explanation

Answer: D. A client whose medications to manage Parkinson's disease are no longer effective.

Rationale:

A) A client who is newly diagnosed with type 1 diabetes mellitus and cannot afford insulin:

While this client has a significant medical issue, the primary concern here is financial rather than palliative. Palliative care focuses on providing relief from symptoms and improving quality of life for those with serious illnesses. Addressing the client's financial issues might involve social services or community resources rather than palliative care.

B) A client who has Meniere's disease and cannot safely ambulate due to vertigo:

Meniere's disease, while debilitating, may not necessarily require palliative care unless the symptoms are severely impacting the client's quality of life in a way that is not manageable with current treatments. Palliative care could be considered if the disease is severely limiting function and other supportive care is needed.

C) A client who had a stroke and cannot eat or drink without choking:

This client is experiencing a significant functional impairment due to the stroke, which might benefit from rehabilitative services rather than palliative care. Palliative care would be more appropriate if the client's condition is progressive, severe, and not responsive to treatment, leading to a focus on comfort and quality of life.

D) A client whose medications to manage Parkinson's disease are no longer effective:

When medications for Parkinson's disease are no longer effective, the client may be experiencing advanced symptoms and a decline in quality of life. Palliative care can provide symptom management, support, and enhance the client's quality of life when conventional treatments are no longer effective in controlling symptoms.

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A nurse in an emergency department is caring for a client who is in a sickle cell crisis. Which of the following actions should the nurse take?(Select all that apply.).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who is receiving brachytherapy. Which of the following interventions should the nurse include in the plan of care?

Correct Answer is A

Explanation

A nurse is assessing a group of clients. For which of the following clients should the nurse make a referral to palliative care?

Correct Answer is D

Explanation

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