An 18-year-old patient with a known history of sickle cell anemia presents to the emergency department with severe pain in the lower back and joints, fever, and signs of dehydration. What is the most appropriate initial nursing intervention?
Administer intravenous fluids and pain management as prescribed.
Apply cold compresses to the painful areas to reduce inflammation.
Administer antibiotics immediately to treat the underlying infection.
Encourage the patient to perform light exercise to promote circulation.
The Correct Answer is A
Choice A Reason:
Administering intravenous fluids and pain management is the most appropriate initial intervention for a patient with sickle cell anemia presenting with severe pain, fever, and dehydration. Sickle cell crises often lead to severe pain due to vaso-occlusion, where sickled red blood cells block blood flow to various parts of the body. Intravenous fluids help to rehydrate the patient and reduce blood viscosity, which can alleviate the vaso-occlusive crisis. Pain management is crucial to provide relief and improve the patient’s comfort. This approach addresses the immediate symptoms and stabilizes the patient.
Choice B Reason:
Applying cold compresses to the painful areas is not recommended for patients with sickle cell anemia. Cold can cause vasoconstriction, which may worsen the vaso-occlusion and increase pain. Instead, warm compresses are often suggested to help dilate blood vessels and improve blood flow.
Choice C Reason:
Administering antibiotics immediately is not the primary intervention unless there is a clear indication of an infection. While fever can be a sign of infection, it can also occur due to the inflammatory response associated with a sickle cell crisis. The priority is to manage pain and dehydration first, and then evaluate the need for antibiotics based on clinical findings.
Choice D Reason:
Encouraging the patient to perform light exercise is not appropriate during an acute sickle cell crisis. Physical activity can increase oxygen demand and exacerbate the pain and vaso-occlusion. Rest and adequate hydration are more suitable to manage the crisis effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Storing hearing aids in a dry, cool place when not in use is crucial for maintaining their functionality and longevity. Moisture and heat can damage the delicate electronic components of hearing aids. Using a dehumidifier specifically designed for hearing aids can help prevent moisture buildup and extend the life of the devices.
Choice B Reason:
Using cotton swabs to clean the interior components of the hearing aid is not recommended. Cotton swabs can push debris further into the hearing aid and potentially damage the internal components. Instead, specialized cleaning tools such as wax loops, brushes, and earmold tubing blowers should be used to clean hearing aids properly.
Choice C Reason:
It is not okay to wear hearing aids while showering or swimming. Most hearing aids are water-resistant but not waterproof. Exposure to water can damage the hearing aids and affect their performance. It is important to remove hearing aids before any activities involving water.
Choice D Reason:
Replacing the batteries of hearing aids once a month regardless of usage is not necessary. Battery life depends on the type of hearing aid, the battery size, and the amount of usage. It is more practical to replace the batteries when they are low or depleted, as indicated by the hearing aid’s low battery warning.
Correct Answer is A
Explanation
Choice A Reason:
An adenoma of the parathyroid gland is the most common cause of primary hyperparathyroidism. This benign tumor leads to the overproduction of parathyroid hormone (PTH), which in turn causes elevated calcium levels in the blood. The excessive PTH secretion disrupts the normal calcium balance, leading to symptoms such as fatigue, muscle weakness, and depression. Parathyroid adenomas account for approximately 80% of primary hyperparathyroidism cases.
Choice B Reason:
Thyroid carcinoma is a type of cancer that originates in the thyroid gland, not the parathyroid glands. While thyroid carcinoma can cause various symptoms, it does not typically lead to elevated PTH levels or hyperparathyroidism. Therefore, it is not the most likely cause of the patient’s condition.
Choice C Reason:
Vitamin D deficiency can lead to secondary hyperparathyroidism, where low levels of vitamin D cause decreased calcium absorption, prompting the parathyroid glands to produce more PTH to maintain calcium levels. However, this condition is usually associated with low or normal calcium levels, not elevated calcium levels as seen in this patient. Therefore, it is not the most likely cause of her hyperparathyroidism.
Choice D Reason:
Chronic kidney disease (CKD) can also cause secondary hyperparathyroidism due to impaired kidney function, which affects calcium and phosphate balance and vitamin D metabolism. However, similar to vitamin D deficiency, CKD-related hyperparathyroidism typically presents with low or normal calcium levels rather than elevated levels. Thus, it is not the most likely cause in this scenario.
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