Download NUR 211 Final Exam Test Bank: Sickle Cell Disease - 500+ Q&A and more Exams Nursing in PDF only on Docsity!
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A nurse caring for a client with sickle cell disease (SCD) reviews the client's laboratory work. Which finding should the nurse report to the provider? A. Creatinine: 2. B. Hematocrit: 30% C. Sodium: 147 D. WBC: 12, A. Creatinine: 2. An elevated creatinine indicates kidney damage, which occurs in SCD. A hematocrit level of 30% is an expected finding, as is a slightly elevated white blood cell count. Sodium of 147, although slightly high, is not concerning A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best? A. Give the client pain medication if it is time for another dose. B. Instruct the client not to request pain medication too early. C. Request the provider to leave a prescription for a placebo D. Tell the client it is too early to have more pain medication A. Give the client pain medication it it is time for another dose. Clients with sickle cell crisis often have severe pain that is managed with up to 48 hours of IV opioid analgesics. Even if the client is addicted and drug seeking, he
or she is still in extreme pain. If the client can receive another doe of medication, the nurse should provide it, The other options are judgmental and do not address the client's pain. Giving placebos is unethical. A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best? A. 0.45% normal saline B. 0.9% normal saline C. Dextrose 50% (D50) D. Lactated Ringers solution A. 0.45% normal saline Because clients in sickle cell crisis are often dehydrated, the fluid of choice is a hypotonic solution such as 0.45% normal saline. ).9% normal saline and lactated ringers solution are isotonic. D50 is hypertonic and not used for hydration. A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority? A. Administer oxygen B. Apply an oximetry probe C. Give pain medication D. Start an IV line A. Administer oxygen
B. I can see you are upset. I can stay here with you awhile if you like. The best response is for the nurse to offer self, a therapeutic communication technique that uses presence. Attempting to assign blame to both parents will not help the client feel better. There is genetic testing available, so it is inaccurate to state there is no way to know who will have the disease. Stating that good treatments exist belittles the client's feelings. A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately? A. Hematocrit: 25% B. Hemoglobin: 9. C. Potassium: 3. D. WBC: 38, D. WBC: 38, Although individuals with SCD often have elevated WBC counts, this extreme elevation could indicate leukemia, a complication of taking hydoxyurea. The nurse should report this finding immediately. Alternatively, it could indicate infection, a serious problem for clients with SCD. Hematocrit and hemoglobin levels are normally low in people with SCD. The potassium level, while slightly low, is not worrisome as the WBCs.
A nurse working with clients with sickle cell disease teaches about self- management to prevent exacerbations and sickle cell crisis. What factors should clients be taught to avoid? (Select all that apply) A. Dehydration B. Exercise C. Extreme stress D. High altitudes E. Pregnancy A,C,D,E Several factors cause RBCs to sickle in SCD, including dehydration, extreme stress, high altitudes, and pregnancy. Strenuous exercise can also cause sickling, but not unless it is very vigorous. The nurse is teaching a client who has sickle cell disease and was admitted for splenomegaly and abdominal pain. Which instruction does the nurse include in the clients discharge teaching? A. Avoid drinking large amounts of fluids B. Eat six small meals daily instead of large meals C. Engage in aerobic 3 days a week D. Receive a yearly influenza vaccination D. Receive a yearly influenza vaccination Abdominal pain and a palpable spleen could indicate blood trapped in the spleen. Over time, the spleen may become nonfunctional, which the client at risk for infection. An annual influenza vaccination helps prevent infection. A client with
D. WBC: 12,
C. Serum iron level: 300 Clients with sickle cell disease are anemic but are not iron deficient. Transfusions are prescribed cautiously to prevent iron overload with repeated transfusions. Iron overload damages the heart, liver, and endocrine organs. monitor the client's serum ferritin, serum iron, and total iron- binding capacity during transfusion therapy. the other laboratory values should not result in discontinuation of the transfusion by the nurse. A client is newly diagnosed with sickle cell anemia. Which information does the nurse include in the clients discharge instructions? A. Eat a diet high in iron B. Take hydoxyurea every morning C. Be aware of the early symptoms of crisis D. Do not use any oral contraceptives C. Be aware of the early symptoms of crisis Clients need to know the early symptoms of crisis so that treatment can be started early to prevent pain, complications, and permanent tissue damage. The iron level is not low in sickle cell anemia. Hydroxyurea is used in the hospital during sickle cell crisis. The use of oral contraceptives is controversial because they kay enhance clot formation, predisposing the client to crisis.
A client who has sickle cell anemia is admitted to the hospital. The client reports severe pain. Which action will the nurse take first? A. Administer one unit of packed red blood cells B. Administer prescribe hydroxyurea C. Begin intravenous fluids at 250 mL/hr D. Prepare for bone marrow transplantation C. Begin intravenous fluids at 250 mL/hr All of these are treatments for sickle cell anemia. However, the client in severe pain is likely to be in sickle cell crisis. To prevent further sickling of the red blood cells, adequate hydration of at least 200 mL/hr is needed during a crisis. the other interventions should be implemented after the fluids are started The regulation of red blood cell production is thought to be controlled by which physiologic factor? A. Hemoglobin B. Tissue hypoxia C. Reticulocyte count D. Number of RBCs B. Tissue hypoxia Hemoglobin does not directly control RBC production. If there is insufficient hemoglobin to adequately oxygenate the tissue, then erythropoietin may be released. When tissue hypoxia occurs, the kidneys release erythropoietin into the
B.All siblings will have SCA C. Each sibling has a 25% chance of having SCA D. There is a 50% chance of siblings having SCA C. Each sibling has a 25% chance of having SCA SCA is inherited as an autosomal recessive disorder. In this inheritance pattern, each child born to these parents has a 25% chance of having the disorder, a 25% chance of have neither SCA nor the trait, and a 50% chance of being heterozygous for SCA. SCA is an inherited hemoglobinopathy The clinical manifestations of sickle cell anemia (SCA) are primarily the result of which physiologic alteration? A. Decreased blood viscosity B. Deficiency in coagulation C. Increased RBC destruction D. Greater affinity for oxygen C. Increased RBC destruction The clinical features of SCA are primarily the result of increased RBC destruction and obstruction caused by the sickle-shaped RBCs. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation. SCA dose not have a coagulation deficit. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension
A school-age child is admitted in vasooclusive sickle cell crisis (pain episode). The child's care should include which therapeutic interventions? A. Hydration and pain management B. Oxygenation and factor VIII replacement C. Electrolyte replacement and administration of heparin D. Correction of alkalosis and reduction of energy expenditure A. Hydration and pain management The management of crises include adequate hydration, pain management, minimization of energy expenditures, electrolyte replacement, and blood component therapy if indicated. Factor VIII is not indicated in the treatment of vaso-occlusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels. Also, prolonged oxygen can reduce bone marrow activity. heparin is not indicated in the treatment of vaso-occlusive sickle cell crisis. electrolyte replacement should accompany hydration. The acidosis will be corrected as the crisis is treated. Energy expenditure should be minimized to improve oxygen utilization. Acidosis, not alkalosis, results from hypoxia, which also promotes sickling. A child with sickle ell anemia develops severe chest pain and back pain, fever, cough, and dyspnea. What should be the first action by the nurse? A. Administer 100% oxygen to relieve hypoxia B. Notify the practitioner because chest syndrome is suspected C. Infuse intravenous antibiotics as soon as cultures are obtained D. Give ordered pain medication to relieve symptoms of pain episode
A 5-year-old child is admitted to the hospital in a sickle cell crisis. The child has been alert and oriented but in severe pain. The nurse notes that the child is complaining of headache and is having unilateral hemiplegia. What action should the nurse implement? A. Notify the health care provider B. Place the child on bed rest C. Administer a dose of hydrocodone (Vicodin) D. Start Ó per the hospitals protocol. A. Notify the health care provider Any number of neurologic symptoms can indicate a minor cerebral insult, such as headache, aphasia, weakness, convulsions, visual disturbances, or unilateral hemiplegia. Loss of vision is usually the result of progressive retinopathy and retinal detachment. The nurse should notify the health care provider. What pain medication is contraindicated in children with sickle cell disease (SCD)? A. Meperidine B. Hydrocodone C. Morphine sulfate D. Ketorolac A. Meperidine Meperidine is not recommended. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and
generalized seizures when is accumulates with repetitive dosing. Patients with SCD are particularly at risk for normeperidine-induced seizures. A child with sickle cell disease is vase-occlusive crisis. What nonpharmacologic pain intervention should the nurse plan? A. Exercise as a distraction B. Heat to the affected area C. Elevation of the extremity D. Cold compresses to the affected area B. Heat to the affected area Frequently, heat to the affected area is soothing. Cold compresses are not applied to the area because doing so enhances vasoconstriction and occlusion. bed rest is usually well tolerated during a crisis, altho the actual ret obtained depends a great deal on pain alleviation and the use of organized schedules of nursing care. Although the objective of bed rest s to minimize oxygen consumption, some activity, particularly passive range of motion exercises, is beneficial to promote circulation. Usually the best course is to let children determine their activity tolerance. elevating the extremity will not help in sickle cell disease. The nurse is caring for a patient with increased intracranial pressure. Which action is considered unsafe? A. Aligning the neck with the body B. Clustering many nursing activities C. Elevating the head of the bed 30 degrees
When caring for the patient after a head injury, the nurse would be most concerned with assessment findings which included respiratory changes A. Hypertension, and bradycardia B. Hypertension, and tachycardia C. Hypotension, and bradycardia D. Hypotension, and tachycardia A. Hypertension, and Bradycardia Hypertension with widening pulse pressure, bradycardia, and respiratory changes are the ominous late stages of increased ICP and indications of impending herniation (Cushing's trail). It is bradycardia, not tachycardia, which is the component of this ominous trait. It is hypertension, not hypotension, which is the component of the ominous triad. Components of the GCS the nurse would use to assess a patient after a head injury include A. Blood pressure B. Cranial nerve function C. Head circumference D. Verbal responsiveness D. Verbal responsiveness
Components of GCS include eye opening, motor responsiveness , and verbal responsiveness. The nurse would want to assess the blood pressure, but this is not a component of comma scale. Assessment of cranial nerve function is appropriate as alterations such as cranial nerve VI palsies may occur, but this is not part of the coma scale. Increases in head circumference are associated with alterations in ICP in infants, but this is not part of the coma scale. Primary prevention strategies to reduce the occurrence of head injuries would include A. Blood pressure control B. Smoking cessation C. Maintaining a healthy weight D. Violence prevention D. Violence prevention Injury prevention measures such as wearing a seat belt, helmet use, firearm safety, and violence prevention programs reduce the risk of traumatic brain injuries. Blood pressure control and exercising can decrease the risk of vascular disease, impacting the cerebral arteries, rather than head injuries. Smoking cessation is one primary prevention strategy which can decrease the risk of vascular disease. Maintaining a healthy weight can decrease the risk of vascular disease. A nurse plans care for a client who has a hypoactive response to a test of deep tendon reflexes. Which intervention should the nurse include in this client's plan of care?
A nurse assesses a client who demonstrates a positive Romberg's sign with eyes closed but not with eyes open. Which condition does the nurse associate with this finding? A. Difficulty with proprioception B. Peripheral motor disorder C. Impaired cerebella function D. Positive pronator drift A. Difficulty with proprioception The client who sways with eyes closed (positive Romberg's sign) but not with eyes open most likely has a disorder of proprioception and uses vision to compensate for it. The other options do not describe a positive Romberg's sign A nurse asks a client to take deep breaths during electroencephalography. The client asks, Why are you asking me to do this? How should the nurse respond? A. Hyperventilation causes vascular dilation of cerebral arteries, which decreases electoral activity in the brain B. Deep breathing helps you relax and allows the electroencephalogram to obtain a better waveform C. Hyperventilation causes cerebral vasoconstriction and increases the likelihood of seizure activity D. Deep breathing will help you to blow off carbon dioxide and decreases intracranial pressure
C. Hyperventilation causes cerebral vasoconstriction and increases the likelihood of seizure activity Hyperventilation produces cerebral vasoconstriction and alkalosis, which increases the likelihood of seizure activity. The client is asked to breath deeply 20 - 30 times for 3 minutes. the other responses are not accurate. A nurse assesses a client recovering from a cerebral angiography via the clients femoral artery. Which assessment should the nurse complete? A. Palpate bilateral lower extremity pulses B. Obtain orthostatic blood pressure readings C. Perform a funduscopic examination D. Assess the gag reflex prior to eating A. Palpate bilateral lower extremity pulses Cerebral angiography is performed by threading a catheter through the femoral or brachial artery. The extremity is kept immobilized after the procedure. The nurse checks the extremity for adequate circulation by noting skin color and temperature, presences and quality of pulses distal to the injection site, and capillary refill. Clients usually are on bedrest; therefore, orthostatic blood pressure readings cannot be performed. The funduscopic examination would be affected by cerebral angiography. The client is given analgesics but not conscious sedation; therefore, the clients gag reflex would not be compormised.
