A nurse is contributing to the plan of care for a child who has sickle cell crisis. Which of the following actions should the nurse recommend to include?

Apply cold compresses to the affected areas.

Implement pain management on a PRN basis.

Active range-of-motion (ROM) exercises daily.

Promote hydration with IV and oral fluids.

Answer and Explanation

The Correct Answer is D

A. Apply cold compresses to the affected areas. Cold can cause vasoconstriction, which may worsen the sickling and pain. Heat packs are generally recommended to promote circulation and relieve pain.
B. Implement pain management on a PRN basis. Pain management should be consistent and proactive rather than PRN (as needed). Regular pain control is essential in managing sickle cell crises.
C. Active range-of-motion (ROM) exercises daily. During a crisis, the child should rest and avoid physical activity to prevent further pain and complications. ROM exercises are more appropriate during non-crisis times for maintaining joint function.
D. Promote hydration with IV and oral fluids. Hydration is crucial during a sickle cell crisis as it helps to decrease blood viscosity, reducing the risk of further sickling and vaso-occlusive events.

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Correct Answer is A

Explanation

A. Initiate isotonic fluids with 20 mEq/L potassium chloride. The priority in treating acute gastroenteritis in a toddler is to manage dehydration, which is often severe due to fluid loss from vomiting and diarrhea. Isotonic fluids with electrolytes like potassium chloride help to restore fluid balance and prevent complications like electrolyte imbalances. This is the most urgent action to stabilize the child's condition.
B. Request evaluation of the toddler's serum electrolytes. While important, this can be done after fluid resuscitation has begun to assess the severity of electrolyte imbalances.
C. Determine if the toddler is voiding. Important for assessing renal function, but not the first priority in acute gastroenteritis.
D. Collect a stool sample from the toddler. Useful for identifying the causative organism but not as urgent as fluid resuscitation.

A. Give the child 1⁄2 cup of orange juice to drink. B. Call the dietary department and ask that the lunch tray be delivered early. C. Contact the physician. D. Obtain a blood glucose reading

Correct Answer is A

Explanation

A. Give the child 1⁄2 cup of orange juice to drink. These symptoms indicate hypoglycemia, a common early complication of diabetes treatment. Orange juice contains quick-acting sugars that can rapidly raise blood glucose levels and alleviate symptoms. This is the immediate action to manage the child's symptoms.
B. Call the dietary department and ask that the lunch tray be delivered early. Delayed action compared to treating the immediate hypoglycemia.
C. Contact the physician. While eventually necessary, immediate treatment of hypoglycemia takes precedence.
D. Obtain a blood glucose reading. Important to confirm hypoglycemia but not as urgent as providing immediate treatment.

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