Next-Gen Pediatric Case 7: Brittany Long (Core):Pre-Simulation Quiz

A nurse is explaining the pathophysiology of vaso-occlusive pain crisis to the caregiver of a patient with sickle cell anemia. Which explanation by the nurse is correct? 'Bone marrow suppression occurs because of the development of sickled cells, which makes your child less able to fight infections.' 'Sickled cells cause increased blood flow throughout the body. The increased blood flow through the blood vessels causes your child to have severe pain.' 'Sickled cells mix with normal red blood cells and cause the immune system to become depressed, which makes your child more prone to illness.' '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.'

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.' Rationale:Sickle cell vaso-occlusive pain crisis occurs when sickled cells clump in the microvasculature, impeding blood flow (not increasing it); this causes local tissue hypoxia, which progresses to ischemia, resulting in severe pain as circulation to the affected area decreases. Bone marrow suppression and immune system depression are not involved in the pathophysiology of vaso-occlusive pain crisis. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 869-870

A nurse is caring for a pediatric patient who was recently diagnosed with sickle cell anemia. The patient's biological mother says, 'I don't understand how one of my children contracted this disease when the other doesn't have it.' In which way should the nurse respond? "Sickle cell anemia is transmitted through one biological parent. If you have four children, one—or 25%—will have sickle cell anemia." 'You must have only transmitted sickle cell anemia to one of your children. Your other child definitely carries the trait.' 'Sickle cell anemia is not genetically transmitted.' 'Because both biological parents have the sickle cell trait, your risk for having a child with sickle cell anemia is 25% with each pregnancy.'

'Because both biological parents have the sickle cell trait, your risk for having a child with sickle cell anemia is 25% with each pregnancy.' Rationale:Sickle cell anemia is an autosomal recessive disorder; both parents must have the trait for a child to have the disease. With each pregnancy, there is a 25% chance the child will have sickle cell anemia, a 50% chance the child will be a carrier of the trait, and a 25% chance the child will be unaffected. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 869-870, Figure 24.8Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 973-976

The nurse is performing a physical assessment on a 5-year-old patient. Which statement 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.' 'I am going to take your temperature and blood pressure now.' 'You need to change into a hospital gown before I can examine you.' 'Your parent will need to wait outside while I complete your assessment.'

'I want to listen to you breathe. I need you to help me hold my stethoscope in place.' Rationale:Preschoolers should be given a job during the assessment process, such as holding the stethoscope or pen light. The nurse should avoid using confusing terms such as temperature, blood pressure, or test. Instead, the nurse should say, 'Let's see how warm you are' or 'I want to listen to you breathe.' When assessing a preschool-aged patient, the patient can sit in the caregiver's lap or sit on the exam table within reach and eye contact of the caregiver. Children should never be forced to change into a gown. It is important to allow children to stay in their own clothing and to wear shorts or underwear under a gown if preferred. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 262-265, Table 10.2

The nurse is caring for a patient weighing 16 kg with an order to administer acetaminophen 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? __________ mg

240 Rationale: To determine the maximum safe dose for this patient, multiply the high end of the dosage range by the patient's weight in kilograms: 15 × 16 = 240. Thus, the maximum safe dose is 240 mg. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 355, Box 13.2Lippincott Procedures, Safe Medication Administration Practices, General

A nurse is assessing the pain level of a 5-year-old patient hospitalized with vaso-occlusive pain crisis. Which pain scale would the nurse use to assess this patient? Visual analog scale FACES scale FLACC scale Numeric pain intensity scale (0 to 10)

FACES scale Rationale:The FACES pain rating scale is a self-report tool that is acceptable for use with a developmentally appropriate 5-year-old. Visual analog and numeric scales are for use with patients over 7 or 8 years of age. The FLACC behavioral scale is appropriate for when the patient cannot accurately report their own level of pain due to age or developmental level. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 391-395

A 5-year-old with a history of sickle cell anemia presents to the emergency room with acute leg pain. When obtaining the health history, the nurse should include questions related to which factor(s)? (Select all that apply.) Frequency of vaso-occlusive crises Precipitating events Past hospitalizations and treatment Family history of blood transfusions Immunization history

Frequency of vaso-occlusive crises, Precipitating events, Past hospitalizations and treatment, Immunization history Rationale:When obtaining a health history on a patient with sickle cell anemia, the nurse should elicit information related to growth and development, frequency and extent of vaso-occlusive crises, past hospitalizations and treatment for pain crises, immunization history, personal history of blood transfusions, current medication regimen, and precipitating events. A family history of blood transfusions would not be relevant, as it would not affect the patient. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 870-871

A 5-year-old patient with sickle cell anemia has an order for acetaminophen elixir 240 mg every 6 hours (15 mg/kg/dose) around the clock for pain. Which method is most appropriate for the nurse to employ to administer the medication? Use a dropper to place medication in the back of the patient's throat. Place medication in an oral syringe and allow the patient to squirt into their mouth. Put medication into a medicine cup and pour entire amount into patient's mouth at one time. Hide medication in applesauce or ice cream and have the caregiver feed the patient.

Place medication in an oral syringe and allow the patient to squirt into their mouth. Rationale:The preschool-aged or young school-aged child may enjoy using an oral syringe to squirt medication into their mouth; it is engaging and gives them a sense of control. A dropper is appropriate for use with infants and younger children; older children can take oral medication from a medicine cup or measured medicine spoon. Medication should be placed in the posterior side of the patient's cheek and should be given slowly in small amounts, allowing the patient to swallow before placing more medication into the mouth. To establish and maintain trust, it is important to tell children if there is medication mixed into food. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 356-357

A patient with sickle cell disease experiencing a vaso-occlusive crisis comes to the emergency room for evaluation. Which acute manifestations of vaso-occlusive crisis would the nurse expect to see in this patient? Anemia and hypotension Tachycardia and jaundice Acute leg pain and dactylitis Enuresis and proteinuria

Acute leg pain and dactylitis Rationale:Acute manifestations of sickle cell anemia in a vaso-occlusive crisis include pain crisis and swelling of the fingers and toes (dactylitis). Hypertension and tachycardia are often associated with acute pain. Anemia, jaundice, enuresis, and proteinuria are chronic manifestations of sickle cell anemia. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 871, Comparison Chart 24.3Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 871-872

During the nurse's initial assessment of a 5-year-old child admitted with vaso-occlusive crisis, the patient reports a pain level of 8 on the FACES scale. The patient is lying quietly in bed watching television. Which action would the nurse take? Administer the prescribed analgesic as ordered. Ask the caregiver whether the patient is hurting. Reassess the patient in 15 minutes to see whether the pain rating has changed. Continue to monitor, because the patient appears to be resting.

Administer the prescribed analgesic as ordered. Rationale:The FACES pain rating scale is a self-report tool that can be used by children as young as 3 years of age. A 5-year-old is old enough to accurately report their own pain level and may be lying still as a coping strategy or because movement is painful. Resting quietly or sleeping may be a coping strategy for the patient when experiencing pain or may reflect exhaustion in the patient who is coping with pain. Remediation:Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 392, Figure 14.3