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A nurse is caring for an adolescent.

Exhibits
For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

A.

Ambulate in hallway with supervision

B.

Ketorolac IV for pain

C.

Ice packs to affected area 15 min or 5 min off

D.

Meperidine for pain

E.

Intravenous fluids (IVF) at maintenance rate

F.

Oxygen in 2L/min via nasal cannula

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"C"},"D":{"answers":"C"},"E":{"answers":"A"},"F":{"answers":"B"}}

Potential Order

Anticipated

Nonessential

Contraindicated

Ambulate in hallway with supervision

 

✓

 

Ketorolac IV for pain

✓

 

 

Ice packs to affected area 15 min or 5 min off

 

 

✓

Meperidine for pain

 

 

✓

Intravenous fluids (IVF) at maintenance rate

✓

 

 

Oxygen in 2L/min via nasal cannula

 

✓

 
  • Ambulate in hallway with supervision: While mobility helps prevent complications, it is not a priority during an acute pain crisis. The client is in severe pain and resisting movement, so ambulation would be inappropriate until pain is better controlled.
  • Ketorolac IV for pain: Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is commonly used adjunctively in sickle cell crises for its analgesic and anti-inflammatory effects, especially when opioids alone are ineffective.
  • Ice packs to affected area: Cold therapy causes vasoconstriction, which can worsen sickling and ischemia in clients with sickle cell disease. Heat therapy is preferred for promoting circulation during a vaso-occlusive episode.
  • Meperidine for pain: Meperidine is avoided in sickle cell disease due to the risk of neurotoxicity (e.g., seizures) from its metabolite, normeperidine, especially with repeated doses or in renal impairment.
  • Intravenous fluids (IVF) at maintenance rate: Hydration is critical in sickle cell crises to reduce blood viscosity and prevent further sickling. IV fluids are a standard component of treatment during acute pain episodes.
  • Oxygen 2 L/min via nasal cannula: The client is not hypoxic and has a normal respiratory rate (18 / min), and routine oxygen is not required unless oxygen saturation decreases. Overuse of oxygen can suppress erythropoiesis in chronic use.


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Related Questions

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"C"},"E":{"answers":"C"},"F":{"answers":"A"}}

Explanation

  • "My food will have to be the consistency of pudding.” A Level 3 dysphagia diet includes thickened foods, such as pudding, which reduce the risk of aspiration by being easier to control while swallowing.
  • "I won't be able to eat nuts anymore.” Hard, dry, or crumbly foods like nuts are contraindicated on dysphagia diets because they pose a high choking risk and are difficult to safely swallow.
  • “I will have to stop watching television while I eat.” Distractions during meals should be minimized to promote safe swallowing and focus on the effort required, especially with dysphagia.
  • “I can have cream soups on this diet.” Cream soups are typically too thin unless they are thickened to the appropriate consistency. Unmodified soups increase the risk of aspiration.
  • “I will look up at the ceiling when I swallow.” Tilting the head back can increase aspiration risk. A chin-tuck position is safer as it narrows the airway and provides better control during swallowing.
  • “I shouldn't drink liquids while I have food in my mouth." Liquids and solids together can increase the risk of choking or aspiration. Swallowing them separately helps maintain control of each texture.

Correct Answer is ["0.5"]

Explanation

  • Ensure the units of the desired dose and available dose are the same.
  • Convert milligrams (mg) to micrograms (mcg).

Available dose = 0.25 mg/tablet

1mg=1000mcg

=0.25mg/tablet×1000mcg/mg

= 250mcg/tablet

Desired dose = 125 mcg.

  • Calculate the number of tablets to administer.

Number of tablets = Desired dose (mcg) / Available dose (mcg/tablet)

= 125 mcg / 250 mcg/tablet

= 0.5 tablets.

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