Brittany Long Core

A patient with sickle cell disease experiencing a vaso-occlusive crisis comes to the emergency room for evaluation. Which of the following are acute manifestations of this disease that the nurse should expect to see in this patient?

Acute leg pain and dactylitis

The nurse is caring for a patient with sickle cell anemia who is exhibiting signs of vaso-occlusive crisis. Which of the following should be included in the plan of care for this patient?

Administer oxygen if saturations are less than 92% to promote adequate oxygenation, Assess pain frequently and administer medications routinely, Administer hypotonic fluids intravenously to promote hemodilution

The nurse is teaching Brittany how to use the FACES scale to rate pain. Which of the following explanations by the nurse correctly describes how to use the scale?

Choose the face that looks like how you feel inside. You don't have to be crying to be hurting a lot.

The nurse is performing a physical assessment on a 5-year-old patient. Which of the following demonstrates that the nurse understands developmentally appropriate communication?

I want to listen to you breathe. I need you to help me hold my stethoscope in place.

A 5-year-old comes to the emergency room with a history of sickle cell anemia and acute leg pain. When obtaining the health history, the nurse should include questions related to which of the following? (Select all that apply.)

Immunization history, Past hospitalizations and treatment, Frequency of vaso-occlusive crises, Precipitating events

A nurse is caring for a patient with sickle cell anemia exhibiting signs of vaso-occlusive crisis. Which of the following would be the highest priority and most appropriate nursing diagnosis in this case?

Acute pain related to tissue ischemia

A patient came to the emergency room with acute pain crisis secondary to sickle cell anemia. The patient received morphine sulfate intravenously 1 hour ago for severe pain and is awake, alert, and complaining of generalized itching. On inspection, the patient's skin is flat and without erythema. What action should the nurse take?

Call the provider and request an order for a medication for the itching as needed.

While the nurse assesses Brittany, her mother questions why the nurse is checking the patient's heart and lungs when the admitting complaint was leg pain. The nurse is assessing Brittany for which of the following complications of vaso-occlusive crisis?

Chest syndrome

A 5-year-old patient with sickle cell anemia has an order for oral codeine elixir 8 mg every 4 hours around the clock for pain. Which of the following methods is most appropriate for the nurse to employ to administer the medication?

Place medication in an oral syringe and allow the patient to squirt into his or her mouth

A nurse is explaining the pathophysiology of vaso-occlusive pain crisis to the parent of a patient with sickle cell anemia. Which of the following explanations by the nurse is correct?

Sickled cells clump together and cause the blood to become thicker, preventing blood flow through smaller vessels, causing decreased oxygenation and increased pain in the affected area.

During the nurse's initial assessment of a 5-year-old admitted with vaso-occlusive crisis, the patient reports a pain level of 4 on the FACES scale. The patient is lying quietly in bed watching television. Which of the following should the nurse do?

Administer the prescribed analgesic as ordered

The nurse is reviewing laboratory data on a patient with sickle cell anemia. Which laboratory findings would indicate the patient is experiencing a vaso-occlusive crisis?

Decreased hemoglobin, increased platelet count, and greatly elevated reticulocyte count

After the nurse has given discharge instructions regarding prevention of vaso-occlusive pain crises, which response by Brittany's mother indicates that further teaching is needed?

Drinking too much water can trigger another crisis.

A nurse is assessing the pain level of a 5-year-old patient hospitalized with vaso-occlusive pain crisis. Which of the following would be the best scale to use with this patient?

FACES scale

The nurse enters the room to check on Brittany and finds her sitting in bed playing video games with her sister. Vital signs are as follows: temperature, 37.4°C oral; heart rate, 102 beats per minute; respiratory rate, 26 breaths per minute; blood pressure, 100/60 mm Hg; and oxygen saturation, 97%. She rates her pain as 5 out of 5 on the FACES scale. She has weight-appropriate doses of ibuprofen, acetaminophen, and morphine ordered for pain, and all are available to be given at this time. What would be the most appropriate medication for the nurse to administer?

Morphine because the patient reports severe pain

A nurse is caring for pediatric patient who was recently diagnosed with sickle cell anemia. The patient's mother says, "I don't understand how one of my children contracted this disease when the other doesn't have it." Which of the following would be the best response by the nurse?

Both parents have the sickle cell trait, and your risk for having a child with sickle cell anemia is 25% with each pregnancy.

Brittany has been receiving intravenous morphine for pain associated with a vaso-occlusive crisis for 1 week. She has been having increased pain and, based on follow-up pain assessment scores, the morphine is not as effective as it was initially. The provider has increased the morphine dose, but her mother voices concerns that Brittany is addicted to the medication. Which of the following responses by the nurse is correct?

Over time, drug tolerance occurs, requiring higher doses of morphine to relieve Brittany's pain. Tolerance is not addiction.

The nurse is caring for a patient weighing 16 kg with an order to administer acetaminophen (Tylenol) for acute pain crisis. The safe dosage range for children is 10 to 15 mg/kg/dose. What is the maximum safe dose for this patient in milligrams?

240

The nurse is caring for 5-year-old Brittany, who was admitted with vaso-occlusive pain crisis and is reporting pain in her leg. In addition to pharmacologic pain management, what nonpharmacologic pain management strategies can the nurse use for this patient? (Select all that apply.)

Place a heating pad on the patient's leg and have her mother read her a story., Offer the patient a favorite stuffed toy and distract her by asking about the animal., Encourage deep breathing by having the patient blow bubbles.