A school-age child with sickle cell anemia is admitted with a vaso-occlusive crisis. Which nursing action should the nurse prioritize to effectively manage this acute complication and prevent further morbidity?

Promote bed rest without additional pain interventions to allow natural resolution of the crisis.

Limit fluid intake to prevent fluid overload and minimize risk of pulmonary edema during the crisis.

Administer prescribed opioids promptly and encourage oral hydration as tolerated to manage pain and reduce sickling episodes.

Delay opioid administration to assess the child's pain threshold and avoid potential opioid dependence.

Answer and Explanation

The Correct Answer is C

A. Promote bed rest without additional pain interventions to allow natural resolution of the crisis is incorrect. While rest can help conserve energy, pain management is a priority in vaso-occlusive crises. Unmanaged pain can lead to stress-induced complications, prolonged hospital stays, and decreased oxygenation, which may worsen sickling.

B. Limit fluid intake to prevent fluid overload and minimize risk of pulmonary edema during the crisis is incorrect. Hydration is critical during a vaso-occlusive crisis because dehydration increases blood viscosity and promotes further sickling. Limiting fluids can exacerbate the crisis rather than help it.

C. Administer prescribed opioids promptly and encourage oral hydration as tolerated to manage pain and reduce sickling episodes is correct. Prompt administration of opioids (e.g., morphine or hydromorphone) addresses the severe pain associated with vaso-occlusive crises, while hydration helps maintain blood volume and decreases the likelihood of additional sickling. These interventions are central to reducing morbidity and preventing complications such as organ damage or prolonged hypoxia.

D. Delay opioid administration to assess the child's pain threshold and avoid potential opioid dependence is incorrect. Pain should be treated promptly in vaso-occlusive crises. Delaying analgesia increases suffering, can worsen hypoxia, and may lead to more severe complications. Concerns about long-term opioid dependence are secondary to immediate pain control and patient safety.

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Correct Answer is D

Explanation

A. Coarctation of the Aorta is incorrect because this defect causes obstruction of blood flow from the left ventricle to the aorta. It is a pressure load problem (left ventricular hypertension) rather than a left-to-right shunt, and it does not primarily increase pulmonary blood flow.

B. Tetralogy of Fallot is incorrect because this is a cyanotic defect characterized by right-to-left shunting due to pulmonary stenosis and a VSD. Pulmonary blood flow is often decreased rather than increased.

C. Transposition of the Great Arteries is incorrect because this is a cyanotic defect in which the aorta arises from the right ventricle and the pulmonary artery from the left ventricle, resulting in parallel circulation. Pulmonary blood flow is not increased by a left-to-right shunt.

D. Ventricular Septal Defect (VSD) is correct because it is a acyanotic defect that allows blood to flow from the left ventricle (higher pressure) to the right ventricle (lower pressure). This left-to-right shunt increases pulmonary blood flow, which can lead to symptoms such as tachypnea, poor weight gain, and frequent respiratory infections. VSDs are the most common congenital heart defect in infants.

A. "You should be encouraged to eat more of these items to satisfy cravings. B. "This is a normal behavior during pregnancy and does not require intervention." C. This behavior, called PICA, may lead to nutritional deficiencies and should be assessed." D. "PICA only occurs in the first trimester and will resolve on its own."

Correct Answer is C

Explanation

A. "You should be encouraged to eat more of these items to satisfy cravings." is incorrect because consuming non-food items like ice, clay, or dirt can be harmful. These substances may contain toxins or pathogens and can interfere with nutrient absorption. Encouraging this behavior would be unsafe.

B. "This is a normal behavior during pregnancy and does not require intervention." is incorrect because while cravings are common in pregnancy, PICA is an abnormal eating behavior involving non-food items and requires assessment and intervention due to potential health risks.

C. "This behavior, called PICA, may lead to nutritional deficiencies and should be assessed." is correct. PICA is the recurrent consumption of non-nutritive substances and is often associated with iron deficiency anemia and other nutritional deficiencies. The nurse should assess for nutritional status, laboratory abnormalities, and educate the client on potential risks to both mother and fetus.

D. "PICA only occurs in the first trimester and will resolve on its own." is incorrect because PICA can occur at any time during pregnancy and may persist throughout gestation if untreated. It does not resolve spontaneously in all cases.

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A school-age child with sickle cell anemia is admitted with a vaso-occlusive crisis. Which nursing action should the nurse prioritize to effectively manage this acute complication and prevent further morbidity?

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