A patient who has sickle cell disease was admitted with a vaso-occlusive crisis and reports severe abdominal and flank pain. Which of the following analgesic medications will be MOST appropriate to administer to the patient?

Morphine Sulfate 4 mg IV ATC

Fentanyl 25 mcg/hr transdermal patch Now

Ibuprofen 800 mg PO

Hydromorphone liquid 5 mg PO

Answer and Explanation

The Correct Answer is A

A.   Morphine is a strong opioid analgesic that is effective for managing severe pain, especially in acute situations like a vaso-occlusive crisis. Administering it intravenously allows for rapid onset of pain relief, which is critical given the severity of the patient’s symptoms. Continuous dosing (ATC—around the clock) ensures that pain is managed effectively.
B.   Fentanyl patches are typically used for chronic pain management and take time to reach effective levels in the bloodstream (up to 12 hours or longer). In the case of acute severe pain from a vaso- occlusive crisis, this option would not provide immediate relief.
C.   While ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help relieve mild to moderate pain, it is not adequate for severe pain management. Additionally, in the setting of sickle cell disease, patients may be at risk for renal issues, making high doses of NSAIDs potentially harmful.
D.   Hydromorphone is also a strong opioid analgesic; however, administering it orally may not be effective for severe pain management in an acute situation. IV administration of opioids is preferred for immediate and potent pain relief during a vaso-occlusive crisis.

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Correct Answer is ["A","C","D"]

Explanation

A. Trauma can cause an elevated WBC count as part of the body’s response to injury. The immune system reacts to tissue damage by increasing WBC production to facilitate healing and fight potential infections.
B. Hyperglycemia itself does not directly cause an elevated WBC count. However, it may be associated with conditions like diabetes, where infections are more common. Therefore, while hyperglycemia can occur concurrently with elevated WBC counts, it is not a direct cause of the increase.
C. Infection is one of the most common causes of an elevated WBC count. The body responds to infections (bacterial, viral, etc.) by increasing WBC production to help combat the invading pathogens.
D. Inflammation, whether due to autoimmune conditions, allergies, or other causes, can also lead to an increase in WBC count. The inflammatory process triggers the immune response, resulting in elevated levels of white blood cells.
E. While steroid injections can influence WBC counts, they often cause a redistribution of white blood cells rather than an increase in production. Corticosteroids can cause a decrease in certain types of white blood cells (like lymphocytes) but may increase neutrophils due to a release from the bone marrow.

A. Use paper tape on fragile skin B. Provide mouthwash with alcohol for oral care C. Avoid aspirin D. Provide a soft bristle toothbrush or oral sponge E. Teach to use an electric shaver instead of a razor

Correct Answer is ["A","C","D","E"]

Explanation

A. Paper tape is gentler on fragile skin compared to standard adhesive tape. It reduces the risk of skin tears and bleeding, making it a safer option for patients with thrombocytopenia.
B. This option is not advisable. Mouthwash containing alcohol can irritate and dry out the mucous membranes in the mouth, potentially leading to ulcers or bleeding. Instead, an alcohol-free mouthwash should be used for oral care.
C. Aspirin is an antiplatelet agent that can increase the risk of bleeding. Patients on bleeding precautions should avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) to minimize the risk of excessive bleeding.
D. A soft-bristle toothbrush or oral sponge is recommended for oral care to minimize trauma to the gums and mucous membranes. This helps reduce the risk of bleeding in patients with low platelet counts.
E. Using an electric shaver is safer than a traditional razor, as it reduces the risk of cuts and nicks that can lead to bleeding. This precaution is particularly important for patients with thrombocytopenia.

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A patient who has sickle cell disease was admitted with a vaso-occlusive crisis and reports severe abdominal and flank pain. Which of the following analgesic medications will be MOST appropriate to administer to the patient?

Nursing Test Bank

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Explanation

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