The mother of a teenage boy with sickle cell anemia asks the nurse why her son has such horrible pain during a sickle cell crisis. Which of the following is the best response by the nurse?
"Dehydration Is the primary reason for the pain that is experienced during a sickle cell crisis; try to increase your son's fluid intake."
"We really don't know what causes the pain that is experienced during a sickle cell crisis."
"Sickled cells get clogged in the blood vessels, preventing blood from getting to the tissues, which causes the severe pain of a crisis."
"You will need to discuss this with your doctor. I cannot explain why this pain occurs to your son."
The Correct Answer is C
A. "Dehydration Is the primary reason for the pain that is experienced during a sickle cell crisis; try to increase your son's fluid intake."
This response is not the best choice because while dehydration can indeed exacerbate sickle cell crises and lead to complications, it is not the primary reason for the pain experienced during a sickle cell crisis. The severe pain during a crisis is primarily due to vaso-occlusion, where sickled red blood cells block blood flow in the small blood vessels, leading to tissue ischemia and pain. While adequate hydration is important in managing sickle cell disease, it alone does not address the underlying cause of the pain during a crisis.
B. "We really don't know what causes the pain that is experienced during a sickle cell crisis."
This response is not accurate and not the best choice because the medical community does understand the underlying cause of pain during a sickle cell crisis. It is primarily due to vaso-occlusion, as mentioned earlier, where sickled red blood cells block blood flow in the blood vessels.
C. "Sickled cells get clogged in the blood vessels, preventing blood from getting to the tissues, which causes the severe pain of a crisis."
This response is the best choice because it provides an accurate and clear explanation of why individuals with sickle cell anemia experience severe pain during a sickle cell crisis. It addresses the underlying mechanism of vaso-occlusion, where sickled red blood cells block blood flow in the small blood vessels, leading to tissue ischemia and severe pain.
D. "You will need to discuss this with your doctor. I cannot explain why this pain occurs to your
son."
This response is not the best choice because the nurse should be able to provide basic information about the disease and its symptoms to the mother. It's important for healthcare professionals to educate patients and their families about their condition to improve understanding and facilitate better management and coping strategies.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. The pain can be severe and sudden at rest: This statement is more characteristic of unstable angina, where chest pain can occur at rest or with minimal exertion and is often severe and unpredictable.
B. The pain persists with rest and organic nitrates: This statement is more indicative of unstable angina or variant (Prinzmetal's) angina. Stable angina typically improves with rest and nitroglycerin (an organic nitrate).
C. The pain usually lasts longer than 20 minutes: Stable angina pain typically lasts for a few minutes (usually less than 5 to 10 minutes) and resolves with rest or nitroglycerin. Pain lasting longer than 20 minutes may indicate an acute coronary syndrome such as unstable angina or myocardial infarction.
D. Exertion and anxiety can trigger the pain: This statement is accurate for stable angina. Exertion, such as physical activity or emotional stress, can trigger anginal pain in individuals with stable angina due to increased oxygen demand by the heart.
Correct Answer is C
Explanation
A. 120/80 mm Hg or lower:
This blood pressure range is considered normal or optimal for most adults. However, for individuals diagnosed with hypertension, the goal is typically to reduce blood pressure to below 140/90 mm Hg, as maintaining normal blood pressure is not considered a goal for hypertension treatment unless specifically indicated based on individual circumstances.
B. Average of two BP readings of 150/80 mm Hg:
A blood pressure reading of 150/80 mm Hg is elevated and indicates hypertension, especially if consistently elevated across multiple readings. The goal of hypertension treatment is to lower blood pressure to below 140/90 mm Hg, so an average of 150/80 mm Hg would not be considered the goal of treatment.
C. 140/90 mm Hg or lower:
This blood pressure range is commonly recommended as the goal of treatment for individuals with hypertension who otherwise enjoy good health. It represents a balance between effective blood pressure control and minimizing the risk of side effects or complications associated with overly aggressive treatment.
D. 156/96 mm Hg or lower:
While a blood pressure reading of 156/96 mm Hg is elevated and indicates hypertension, the goal of treatment is typically to reduce blood pressure to below 140/90 mm Hg rather than targeting a specific numeric value below 156/96 mm Hg.
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