A nurse is caring for a 12-year-old client who has sickle cell disease.
Complete the following sentence by using the lists of options.
The nurse should anticipate a provider prescription for
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Rationale for correct choices:
• IV hydromorphone: The child is in a vaso-occlusive crisis, where severe pain is the hallmark finding. IV opioids such as hydromorphone are the treatment of choice for rapid pain relief when pain reaches severe levels unrelieved by oral medications.
• Pain: The child reports escalating pain from 7/10 to 10/10 localized in the right knee with swelling and warmth, consistent with vaso-occlusion. Pain control is the immediate priority because inadequate management can worsen stress and sickling.
Rationale for incorrect choices:
• Fresh frozen plasma transfusion: This is not indicated in sickle cell crisis, as there is no coagulopathy or clotting factor deficiency. Plasma transfusion does not treat anemia or vaso-occlusive pain.
• Factor VIII: This therapy is specific to hemophilia A, which involves a clotting factor deficiency. It has no role in the management of sickle cell disease or vaso-occlusive crisis.
• Platelets: The child’s platelet count is elevated at 450,000/mm³, which reflects a reactive process but not a deficiency. Thrombocytopenia is not present, so platelet replacement is unnecessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Oxygen saturation 88%: Low oxygen saturation indicates hypoxemia, which may be related to the child’s underlying cardiac condition but is not a direct contraindication for administering digoxin. The priority concern with digoxin is its cardiac effect.
B. Heart rate 64/min: Digoxin slows the heart rate, and bradycardia is a key sign of toxicity. In school-age children, the medication should be withheld if the heart rate is below 70/min. A heart rate of 64/min meets this threshold, so withholding the drug is appropriate.
C. Respiratory rate 18/min: A respiratory rate of 18/min is within the normal range for a school-age child (approximately 18–30/min). This finding does not warrant withholding digoxin.
D. Urine output 25 mL/hr: While a low urine output can be a sign of poor renal perfusion, which can be a sign of worsening heart failure, it is not a direct contraindication for administering digoxin.
Correct Answer is D
Explanation
A. "The obstruction will be treated with a medication called indomethacin.": Indomethacin is used to close a patent ductus arteriosus, not to correct coarctation of the aorta. In fact, for coarctation, maintaining ductal patency with prostaglandin E may be necessary until surgery is performed.
B. "The cardiologist will monitor your infant closely until they are able to receive treatment with a heart transplant.": Heart transplant is not the standard treatment for coarctation of the aorta. Most infants undergo surgical or catheter-based interventions, which are effective.
C. "Most cases resolve spontaneously without treatment by 12 months of age.": Coarctation of the aorta does not resolve on its own. Without treatment, it can lead to severe complications such as heart failure, hypertension, or even death, making timely intervention critical.
D. "Surgical repair is the recommended treatment for infants younger than 6 months old.": Surgical repair is the treatment of choice for significant coarctation in infants, especially those younger than 6 months, to relieve obstruction and prevent complications such as left ventricular dysfunction and poor systemic perfusion.
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