A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority?
Encouraging the child to take deep breaths hourly
Maintaining fluids through an intravenous line
Beginning active range-of-motion exercises
Seeing that the child ingests a protein-rich diet
The Correct Answer is B
A. Encouraging deep breathing is important for preventing pulmonary complications but is not the priority in managing a vaso-occlusive crisis.
B. Maintaining hydration through intravenous fluids is the priority as it helps to reduce blood viscosity and prevent further sickling of cells, which is critical in managing a vaso-occlusive crisis.
C. Active range-of-motion exercises are important but are not a priority during an acute vaso-occlusive crisis.
D. A protein-rich diet supports overall health but is not immediately relevant to the acute management of a vaso-occlusive crisis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Respiratory rate can be affected by many factors and is not the most reliable indicator of fluid loss.
B. Body weight is the most reliable indicator of fluid loss, as it directly reflects changes in body fluid levels.
C. Blood pressure changes can occur with fluid loss but may not be as sensitive or immediate as changes in body weight.
D. Skin integrity is important to monitor, but changes in body weight provide a more direct measure of fluid status.
Correct Answer is ["200"]
Explanation
To calculate the infusion rate in mL/hr for administering 1 g of ceftriaxone sodium in 100 mL of dextrose 5% in water over 30 minutes, you would use the formula: (Total Volume in mL / Time in hours) = Rate in mL/hr. Since the time frame is 30 minutes, you convert this to hours by dividing by 60, which is 0.5 hours. Therefore, the calculation is 100 mL / 0.5 hours = 200 mL/hr. Rounding to the nearest whole number, the nurse should set the pump to deliver 200 mL/hr.
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