A nurse is assessing a child who is in sickle cell crisis. What findings should the nurse expect?
Constipation
Pain
Bradycardia
High fever
The Correct Answer is B
Choice A rationale
Constipation is not typically associated with a sickle cell crisis. While it can occur due to dehydration, which can trigger a sickle cell crisis, it is not a primary symptom.
Choice B rationale
Pain is the most common symptom of a sickle cell crisis. When sickle-shaped cells block blood flow in the small blood vessels, it can cause severe pain. This pain can occur anywhere in the body, but it most often occurs in the chest, arms, and legs.
Choice C rationale
Bradycardia is not typically a symptom of a sickle cell crisis. Sickle cell crisis primarily affects the blood vessels and does not directly cause a slow heart rate.
Choice D rationale
While a high fever can occur in individuals with sickle cell disease, especially if there is an underlying infection, it is not a primary symptom of a sickle cell crisis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A newborn’s heart rate normally varies between 120 and 160 beats per minute, but it can rise to 180 beats per minute when the infant is crying or drop as low as 80 to 90 beats per minute when in deep sleep. Therefore, an apical heart rate of 130/min is within the normal range for a newborn.
Choice B rationale
There is no need to call the provider for further assessment if the newborn’s heart rate is within the normal range.
Choice C rationale
Preparing the newborn for transport to the NICU is not necessary if the heart rate is within the normal range.
Choice D rationale
Asking another nurse to verify the heart rate is not necessary if the heart rate is within the normal range.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"C"},"C":{"answers":"B"},"D":{"answers":"A"}}
Explanation
Choice A rationale
Intravenous fluids (IVF) at maintenance rate is anticipated for the client. Dehydration can increase the viscosity of the blood and promote sickling in clients with sickle cell disease. Therefore, maintaining hydration is crucial in managing sickle cell crises.
Choice B rationale
Meperidine IV for pain is contraindicated for the client. Meperidine has been associated with a higher risk of seizures, especially in clients with kidney dysfunction, which can occur in sickle cell disease due to sickling in the renal vasculature.
Choice C rationale
Ice packs to the affected area for 15 min on/15 min off is nonessential for the client. While cold therapy can help reduce inflammation and numb pain, it can also lead to vasoconstriction, which can potentially exacerbate sickling. Therefore, it’s generally recommended to use warm compresses rather than ice packs in clients with sickle cell disease.
Choice D rationale
Oxygen 2 L/min via nasal cannula is anticipated for the client. Hypoxia can trigger sickling in clients with sickle cell disease, so oxygen therapy is often used to increase oxygen saturation and reduce the risk of sickling.
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