A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals an oral temperature of 100.5°F and a new onset of fine crackles on lung auscultation. What is the nurse's most appropriate action?

Liaise with the respiratory therapist and consider high flow oxygen.

Inform the primary care provider that the patient may have an infection.

Apply supplementary oxygen by nasal cannula.

Administer bronchodilators by nebulizer.

Answer and Explanation

The Correct Answer is B

A. Inform the primary care provider that the patient may have an infection:
Explanation: The presence of an elevated oral temperature and new onset of fine crackles on lung auscultation suggests a potential respiratory infection, which is a significant concern in a patient with sickle cell disease. Notifying the primary care provider allows for further evaluation and appropriate management of the infection.

B. Liaise with the respiratory therapist and consider high-flow oxygen:
Explanation: While oxygenation may be necessary, especially if the patient is experiencing respiratory distress, addressing the potential infection is the priority. Consulting with the respiratory therapist and considering high-flow oxygen can be part of the overall plan based on the primary care provider's recommendations.

C. Apply supplementary oxygen by nasal cannula:
Explanation: Providing oxygen support may be necessary, but it should be done in consultation with the primary care provider, who can guide the appropriate level of oxygen therapy based on the patient's condition.

D. Administer bronchodilators by nebulizer:
Explanation: Bronchodilators are typically used for conditions like asthma or COPD, and their use might not be the primary intervention in the context of a sickle cell crisis with signs of a potential respiratory infection. Addressing the infection takes precedence, and the primary care provider's input is essential in determining the appropriate course of action.

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Free Nursing Study Resources

Correct Answer is B

Explanation

A. 30 minute onset; 2-hour duration: This does not accurately represent the onset and peak action time of Insulin Lispro.

B. 15 minute onset; 30-60 minutes peak: This is correct. Insulin Lispro has a rapid onset (starts working within 15 minutes) and a peak action time of 30-60 minutes after administration.

C. 2-hour onset; 12-hour duration: This is not accurate for rapid-acting insulin. Rapid-acting insulin has a much quicker onset and shorter duration compared to this option.

D. 15 minute onset; no peak (continuous): While the onset time is correct, stating "no peak" is not entirely accurate. Rapid-acting insulin does have a peak, but it's relatively short, occurring within the first hour after administration.

A. Persistently cold feet B. Acute pain, unrelieved by rest C. The presence of a tingling sensation D. Pain that does not respond to analgesia

Correct Answer is C

Explanation

A. Persistently cold feet:
This may be a sign of poor circulation, which is more associated with peripheral vascular disease than neuropathy.

B. Acute pain, unrelieved by rest:
Acute pain is not typically associated with peripheral neuropathy. Neuropathic pain is often chronic and may include sensations like tingling or burning.

C. The presence of a tingling sensation:
This is correct. Tingling sensations, along with numbness and pain, are common symptoms of peripheral neuropathy in diabetes.

D. Pain that does not respond to analgesia:
While neuropathic pain can be challenging to manage, the primary focus is on the characteristic nature of the pain (tingling, burning) rather than its response to analgesics.

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A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals an oral temperature of 100.5°F and a new onset of fine crackles on lung auscultation. What is the nurse's most appropriate action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with diabetes mellitus is ordered to receive insulin for glucose correction (sliding scale coverage). The nurse knows the rapid acting insulin Insulin Lispro (Humalog) onset and peak action time are:

Correct Answer is B

Explanation

A nurse is assessing a client who has diabetes for the presence of peripheral neuropathy. The nurse should question the client about what sign or symptom that would suggest the possible development of peripheral neuropathy?

Correct Answer is C

Explanation

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what?

A patient is seeing the nurse practitioner for a 6 months checkup for diabetes mellitus. While reviewing the patient's lab results, which lab best represents the patient has good control of the disease?

A client with Cushing's syndrome is receiving education about dietary changes from the nurse. Which statement by the patient demonstrates the need for further teaching?

The nurse teaches a diabetic client about Sick Day Rules. Which patient statement or statements indicate understanding of the Sick Day Rules? (SELECT ALL THAT APPLY)

The nurse instructs the client about the self-administration of insulin. Which statement or statements by the patient indicate a need for further teaching? (SELECT ALL THAT APPLY)

A nurse is caring for a patient with Addison's Disease. Which of the following clinical manifestations should the nurse expect to observe? (SELECT ALL THAT APPLY)

A client with type 1 diabetes mellitus and peripheral neuropathy is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the client?