A nurse is assisting with the plan of care for a client who is experiencing sickle cell crisis. Which of the following interventions should the nurse include in the plan of care?
Provide a diet that is low in protein.
Avoid administration of the influenza vaccine.
Maintain the client on bed rest.
Decrease fluid intake to 1,500 mL daily.
The Correct Answer is C
A. Provide a diet that is low in protein: This is incorrect because clients in sickle cell crisis require a well-balanced diet with adequate protein, along with increased fluid intake to help maintain hydration and reduce the risk of further complications.
B. Avoid administration of the influenza vaccine: This is incorrect because vaccination, including the influenza vaccine, is important for preventing infections that can exacerbate sickle cell crises.
C. Maintain the client on bed rest: This is correct because bed rest helps to reduce the energy expenditure and stress on the body, which can help manage pain and prevent further complications during a sickle cell crisis.
D. Decrease fluid intake to 1,500 mL daily: This is incorrect because increased fluid intake is crucial in sickle cell crisis to help prevent dehydration and promote proper blood flow, thereby reducing the risk of vaso-occlusive episodes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Eat lighter, low-calorie foods first: While light foods can be easier to consume, prioritizing low-calorie foods may not address the client's nutritional needs. The focus should be on high-calorie, high-protein foods to maintain weight and strength.
B. Limit fluid intake during meals: This is correct as limiting fluid intake during meals can help prevent bloating and early satiety, which can be an issue for clients with COPD who have reduced appetite.
C. Eliminate dairy products: There is no general indication to eliminate dairy products unless the client has a specific intolerance or allergy. Dairy products are not universally problematic for clients with COPD.
D. Consume three regular meals daily: Clients with COPD may benefit from smaller, more frequent meals rather than three large meals to prevent feelings of fullness that can reduce appetite and increase shortness of breath.
Correct Answer is D
Explanation
A. A padded tongue blade: A padded tongue blade is not recommended as it can cause injury to both the client and the nurse. It is a common misconception that it should be used during a seizure, but it does not prevent injury.
B. Anticonvulsant medication: While important for managing seizures, anticonvulsant medication is not an equipment item to be placed at the bedside. It is typically administered as per the prescription and monitored by healthcare providers.
C. A nasogastric tube: A nasogastric tube is not relevant for seizure precautions and is used for different medical purposes, such as feeding or gastric decompression.
D. A suction machine: This is correct as a suction machine is essential to clear the airway in case of aspiration during or after a seizure. It helps in maintaining airway patency and preventing complications.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.