The nurse caring for the client diagnosed with sickle cell crisis places priority on which specific goal(s) prior to discharge? (SELECT ALL THAT APPLY)

Decrease fluid intake of 1000 mL/day to prevent fluid overload

The client verbalizes the procedure for a 24-hour urine collection

Oxygenation and perfusion to meet cellular and metabolic needs

Complications are prevented or minimized

Pain is relieved or controlled

Answer and Explanation

Correct Answer : C,D,E

A. Decrease fluid intake of 1000 mL/day to prevent fluid overload: This goal is not appropriate. Clients with sickle cell crisis often require increased fluid intake to prevent dehydration and promote circulation, so limiting fluids is counterproductive.

B. The client verbalizes the procedure for a 24-hour urine collection: While understanding this procedure may be relevant for monitoring kidney function or hydration status, it is not a priority goal directly related to managing sickle cell crisis.
C. Oxygenation and perfusion to meet cellular and metabolic needs: Ensuring adequate oxygenation and perfusion is crucial in managing sickle cell crisis, as compromised blood flow can exacerbate pain and lead to further complications.

D. Complications are prevented or minimized: Preventing complications, such as infections or acute chest syndrome, is a key goal in managing a client with sickle cell disease, making this a critical aspect of discharge planning.

E. Pain is relieved or controlled: Pain management is a primary focus during a sickle cell crisis. Ensuring that pain is effectively managed before discharge is essential for the client's comfort and overall well-being.

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Correct Answer is A

Explanation

A) Maintain IV fluid infusion and assess adequacy of hydration: This is the best nursing action as adequate hydration is crucial in managing sickle cell crisis. It helps to reduce blood viscosity and prevent further sickling of red blood cells, which is especially important in the context of pneumonia, as dehydration can exacerbate the crisis.

B) Provide continuous sedation for pain relief: While managing pain is essential, continuous sedation is not the most appropriate first step in this situation. Pain management should be addressed, but hydration and treating the underlying causes (like pneumonia) take priority.

C) Insert an indwelling (Foley) catheter and monitor hourly urinary output: While monitoring urinary output can be important, it is not the most immediate action in this case. Focus should be on hydration and addressing the sickle cell crisis rather than on urinary output at this time.

D) Prepare for endotracheal intubation and ventilatory support: Although respiratory distress is a concern with pneumonia, the current pulse oximetry reading of 96% indicates adequate oxygenation at this time. Preparing for intubation should not be the first action unless the patient shows signs of respiratory failure or severe distress.

A. Blood urea nitrogen (BUN) 20 mg/d B. Creatinine 2.6 mg/dl C. Hemoglobin 12.8 g/dl D. Potassium 3.8 mEq/L

Correct Answer is B

Explanation

A) Blood urea nitrogen (BUN) 20 mg/dL: While this BUN level is slightly elevated, it is not as concerning as the creatinine level. Elevated BUN can indicate dehydration or other issues but does not necessarily signal acute kidney injury.

B) Creatinine 2.6 mg/dL: This result is the most concerning because it indicates impaired kidney function. Normal creatinine levels are typically between 0.6 and 1.2 mg/dL. An elevated creatinine level suggests that the kidneys are not filtering waste effectively, which is a significant concern for a client with long-standing hypertension.

C) Hemoglobin 12.8 g/dL: This hemoglobin level is within the normal range for adults and does not present an immediate concern.

D) Potassium 3.8 mEq/L: This potassium level is also within the normal range (3.5 to 5.0 mEq/L) and does not raise any alarms in terms of electrolyte imbalances.

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The nurse caring for the client diagnosed with sickle cell crisis places priority on which specific goal(s) prior to discharge? (SELECT ALL THAT APPLY)

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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