A 15 kg child has a urine output of 360 mL during the past 12 hours. Calculate the child’s urine output in mL/kg/hour for this period of time. (Do not enter units).

Choice A reason:

Opioid analgesics are not given as a last resort solely because of the threat of addiction. While the risk of addiction is a concern, opioids are often necessary for managing severe pain, especially in conditions like sickle cell anemia. The American Society of Hematology guidelines emphasize the importance of effective pain management in sickle cell disease, which often includes the use of opioids. The goal is to manage pain effectively while monitoring for signs of misuse or addiction.

Choice B reason:

Opioid analgesics are often ordered and are usually needed for managing severe pain in patients with sickle cell anemia. Pain episodes in sickle cell disease can be extremely severe and debilitating, requiring potent analgesics like morphine for relief. The management of acute vaso-occlusive pain in sickle cell disease often necessitates the use of opioids to provide adequate pain control.

Choice C reason:

Opioid analgesics, when medically indicated and used under proper medical supervision, rarely cause addiction. The risk of addiction is significantly lower when opioids are used appropriately for pain management in a controlled medical setting. The Mayo Clinic highlights that while opioids have addictive properties, their medical use for pain relief, especially in acute settings, is generally safe when monitored by healthcare professionals.

Choice D reason:

Opioid analgesics are not used only if other measures, such as ice packs, are ineffective. While non-pharmacological measures can be part of pain management, opioids are often necessary for managing severe pain episodes in sickle cell disease. The use of opioids is based on the severity of the pain and the clinical judgment of the healthcare provider.

The correct answer is d) Central nervous system.

Choice A reason:

The musculoskeletal system is not primarily affected by abnormal phenylalanine levels. Phenylketonuria (PKU) is a metabolic disorder that primarily impacts the brain and cognitive functions. While muscle weakness can occur due to overall health deterioration, it is not the primary system affected by phenylalanine toxicity.

Choice B reason:

The renal system is not the main target of phenylalanine toxicity. Although the kidneys play a role in filtering blood and excreting waste, the toxic effects of phenylalanine accumulation are more pronounced in the brain. Therefore, the renal system is not the primary system affected by abnormal phenylalanine levels.

Choice C reason:

The GI system, or gastrointestinal system, is not the primary system affected by abnormal phenylalanine levels. While dietary management is crucial for individuals with PKU to control phenylalanine intake, the toxic effects are primarily seen in the brain. The GI system is involved in the absorption and digestion of nutrients, but it is not the main system impacted by phenylalanine toxicity.

Choice D reason:

The central nervous system (CNS) is the primary system affected by abnormal phenylalanine levels. Phenylketonuria (PKU) leads to the accumulation of phenylalanine in the brain, causing severe brain damage and cognitive impairments. High levels of phenylalanine can disrupt neurotransmitter synthesis and brain development, leading to intellectual disabilities and other neurological issues. Therefore, the CNS is the main system impacted by phenylalanine toxicity.