A nurse is assessing a child who has sickle cell anemia and is experiencing a vasoocclusive crisis. Which of the following clinical manifestations should the nurse expect?

Weight gain

Bradypnea

Pain

Diarrhea

Answer and Explanation

The Correct Answer is C

A. Weight gain:

Weight gain is not typically associated with vasoocclusive crisis in sickle cell anemia. In fact, individuals may experience dehydration and weight loss due to increased metabolic demands during a crisis.

B. Bradypnea:

Bradypnea, or slow breathing, is not a characteristic feature of vasoocclusive crisis in sickle cell anemia. Respiratory rate may be normal or increased due to pain or compensatory mechanisms.

C. Pain:

This is the correct option. Pain is the hallmark manifestation of vasoocclusive crisis in sickle cell anemia. The pain can occur anywhere in the body but most commonly affects the bones, joints, abdomen, and chest. The severity of pain can vary from mild to severe and may require hospitalization for pain management.

D. Diarrhea:

Diarrhea is not typically associated with vasoocclusive crisis in sickle cell anemia. Gastrointestinal symptoms such as abdominal pain and nausea may occur, but diarrhea is not a common manifestation of vasoocclusive crisis.

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Correct Answer is B

Explanation

A. "Honor the child's request if she holds her breath.": This instruction is incorrect and potentially dangerous. Giving in to the child's demands when they hold their breath during a temper tantrum can reinforce the behavior and may lead to more frequent and intense tantrums. It's important for parents to remain calm and not give in to unreasonable demands during tantrums.

B. "Establish a structured daily routine for the child.": This instruction is appropriate. A structured daily routine can help toddlers feel secure and provide predictability, which may reduce the likelihood of tantrums. Consistency in meal times, naptimes, and activities can help toddlers know what to expect and feel more in control of their environment.

C. "Place the child in her room alone until the temper tantrum ends.": While it may be necessary to remove a toddler from a potentially dangerous situation during a tantrum, isolating them in their room alone is not recommended. It's important for parents to stay nearby to ensure the child's safety and to provide comfort and support as needed.

D. "Comfort the child during the temper tantrum.": Providing comfort and reassurance to a child during a temper tantrum can be helpful, as long as it's done in a calm and supportive manner. Reassuring words and gentle touch can help the child feel secure and may help to de-escalate the tantrum more quickly.

A. Depressed scalp veins B. Sunken anterior fontanels C. Bulging eyes D. Separated cranial sutures

Correct Answer is D

Explanation

A. Depressed scalp veins: This is an incorrect choice. In hydrocephalus, there is increased pressure within the skull due to the accumulation of cerebrospinal fluid (CSF). This increased pressure typically leads to distended scalp veins rather than depressed ones.

B. Sunken anterior fontanels: This is an incorrect choice. The fontanel, also known as the soft spot on an infant's head, may actually bulge rather than appear sunken in cases of hydrocephalus due to increased intracranial pressure.

C.Bulging eyes:In individuals with hydrocephalus, especially infants and young children, bulging eyes can sometimes occur.The increased pressure inside the skull can affect various structures within the brain, including the optic nerve and the muscles that control eye movement. This can lead to a condition called papilledema, where the optic nerve becomes swollen due to the pressure. Papilledema can cause changes in vision and, in some cases, contribute to the appearance of bulging eyes.

D.Separated cranial sutures:The separation of cranial sutures in hydrocephalus occurs due to the increased pressure from the excess CSF. This pressure can cause the bones of the skull to move apart, leading to visible gaps or widening of the sutures. Clinically, this can be observed through imaging studies such as CT scans or MRI.

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A nurse is assessing a child who has sickle cell anemia and is experiencing a vasoocclusive crisis. Which of the following clinical manifestations should the nurse expect?

Nursing Test Bank

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