The mother of a 10-year-old who has sickle cell anemia expresses concern that her child will become addicted to pain medication if she follows the instructions on the prescription. Which information is most important for the nurse to provide?
The use of hot baths can be used as an alternative for pain medication.
The child should be encouraged to rest when he experiences pain.
Encourage quiet activities such as watching television as a pain distractor.
Giving pain medication around the clock will help control the pain.
The Correct Answer is D
Sickle cell anemia involves the production of abnormal hemoglobin S, causing crescent-shaped erythrocytes that obstruct microvascular flow. This vaso-occlusive crisis leads to severe tissue ischemia, infarction, and excruciating bone pain. Effective management requires prophylactic analgesia and aggressive hydration to maintain perfusion and prevent chronic organ damage from repetitive sickling episodes.
Rationale:
A. While warmth can promote vasodilation, it is not a substitute for pharmacological intervention during a crisis. Relying on non-pharmacological methods alone fails to address the underlying ischemia. Over-reliance on alternative therapy can lead to uncontrolled pain and increased physiological stress for the child.
B. Rest is necessary to reduce metabolic oxygen demand, but it does not treat the physiological cause of the pain. Without analgesic administration, the child remains at risk for complications like acute chest syndrome. Proper pain management must be the priority to ensure the child can eventually mobilize.
C. Distraction techniques like television are supplementary and cannot manage the high-intensity pain associated with sickling. Educational efforts must clarify that therapeutic opioids used for organic pain rarely result in addiction. Maintaining consistent blood levels of medication is essential for pediatric sickle cell patients.
D. Administering analgesics around the clock ensures a steady state of medication, preventing pain from becoming unbearable. This approach is superior to as-needed dosing because it targets the continuous ischemia present during a crisis. Preventing the peak-and-trough effect of pain minimizes the total dose required for relief.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Acute kidney injury is characterized by a sudden reduction in glomerular filtration rate, leading to the accumulation of nitrogenous waste and fluid overload. Mannitol is an osmotic diuretic used to expand circulating volume and increase renal blood flow. However, because it draws fluid into the intravascular space, it poses a severe risk of pulmonary edema and heart failure in patients with impaired renal excretion.
Rationale:
A. Collecting a clean catch urine specimen is useful for identifying urinary tract infections or assessing for cellular casts in the sediment. While diagnostic, it does not address the immediate hemodynamic safety concerns associated with administering an osmotic agent. The nurse must prioritize assessments that detect acute fluid shifts rather than routine laboratory specimen collection.
B. Obtaining vital signs and breath sounds is the priority intervention. Mannitol rapidly increases the osmotic pressure of the plasma, pulling water from the cells into the vascular compartment. If the kidneys cannot excrete this sudden volume, the client may develop adventitious lung sounds and hypertension, indicating potentially fatal acute circulatory overload and pulmonary congestion.
C. Instructing the client to empty the bladder is necessary for accurate hourly output monitoring during a fluid challenge. However, this action does not provide data on the client's cardiopulmonary tolerance to the medication. The nurse should verify that the client can handle the increased volume before focusing on the mechanical voiding process.
D. No specific nursing action is required is an incorrect statement because mannitol is a high-alert medication in renal failure. Failure to perform a baseline assessment of respiratory status can lead to unrecognized respiratory distress. The nurse is legally and professionally obligated to establish baseline parameters before initiating any treatment that alters systemic fluid distribution.
Correct Answer is ["1.6"]
Explanation
Pediatric medication administration requires extreme precision because dosage is typically calculated based on the child's weight (mg/kg) rather than a standard adult dose. Because children have different metabolic rates and smaller volumes of distribution, even minor errors in calculation or rounding can lead to sub-therapeutic levels or toxicity.
Rationale:
Step 1: Calculate total daily dose
Total daily dose (mg/day) = Weight × Dose per kg/day
= 6.5 × 0.5
= 3.25 mg/day
Step 2: Determine dose per administration
Medication is given every 12 hours = 2 doses/day
Dose per dose = 3.25 ÷ 2
= 1.625 mg
Step 3: Round to the nearest tenth
≈ 1.6 mg
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