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The mother of a teenage boy with sickle cell anemia asks the nurse why her son has such horrible pain during a sickle cell crisis. Which of the following is the best response by the nurse?

"Dehydration Is the primary reason for the pain that is experienced during a sickle cell crisis; try to increase your son's fluid intake."

"We really don't know what causes the pain that is experienced during a sickle cell crisis."

"Sickled cells get clogged in the blood vessels, preventing blood from getting to the tissues, which causes the severe pain of a crisis."

"You will need to discuss this with your doctor. I cannot explain why this pain occurs to your son."

Answer and Explanation

The Correct Answer is C

A. "Dehydration Is the primary reason for the pain that is experienced during a sickle cell crisis; try to increase your son's fluid intake."

This response is not the best choice because while dehydration can indeed exacerbate sickle cell crises and lead to complications, it is not the primary reason for the pain experienced during a sickle cell crisis. The severe pain during a crisis is primarily due to vaso-occlusion, where sickled red blood cells block blood flow in the small blood vessels, leading to tissue ischemia and pain. While adequate hydration is important in managing sickle cell disease, it alone does not address the underlying cause of the pain during a crisis.

B. "We really don't know what causes the pain that is experienced during a sickle cell crisis."

This response is not accurate and not the best choice because the medical community does understand the underlying cause of pain during a sickle cell crisis. It is primarily due to vaso-occlusion, as mentioned earlier, where sickled red blood cells block blood flow in the blood vessels.

C. "Sickled cells get clogged in the blood vessels, preventing blood from getting to the tissues, which causes the severe pain of a crisis."

This response is the best choice because it provides an accurate and clear explanation of why individuals with sickle cell anemia experience severe pain during a sickle cell crisis. It addresses the underlying mechanism of vaso-occlusion, where sickled red blood cells block blood flow in the small blood vessels, leading to tissue ischemia and severe pain.

D. "You will need to discuss this with your doctor. I cannot explain why this pain occurs to your

son."

This response is not the best choice because the nurse should be able to provide basic information about the disease and its symptoms to the mother. It's important for healthcare professionals to educate patients and their families about their condition to improve understanding and facilitate better management and coping strategies.

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Correct Answer is B

Explanation

A. "Cardiac enzymes assist in diagnosing the presence of pulmonary congestion.": Cardiac enzymes are not used to diagnose pulmonary congestion. They are specific markers used to assess damage to the heart muscle, particularly after a myocardial infarction (MI).

B. "These tests help determine the degree of damage to the heart tissues.": This statement is correct. Cardiac enzyme studies, such as troponin levels, CK-MB (creatine kinase-MB), and LDH (lactate dehydrogenase), are used to evaluate the extent of myocardial damage during and after an MI. Elevated levels of these enzymes indicate myocardial injury.

C. "These tests will enable the provider to determine the heart structure.": While cardiac imaging studies like echocardiograms or angiograms are used to assess heart structure, cardiac enzymes are primarily used to evaluate myocardial damage and not heart structure.

D. "Cardiac enzymes will identify the location of the MI.": Cardiac enzymes can indicate the presence of an MI and the extent of myocardial damage, but they do not specifically identify the location of the MI within the heart. Additional diagnostic tests, such as electrocardiograms (ECGs) and imaging studies, are often used to determine the location of the MI.

A. The symptoms indicate an acute coronary episode and should be treated as such. B. The symptoms indicate angina and should be treated as such. C. Treatment should be determined pending the results of an exercise stress test. D. The symptoms indicate a pulmonary etiology rather than a cardiac etiology.

Correct Answer is A

Explanation

A. The symptoms indicate an acute coronary episode and should be treated as such:

The client's symptoms, including sudden midsternal chest pain unrelieved with rest and a history of coronary artery disease (CAD), strongly suggest an acute coronary event, such as a myocardial infarction (heart attack). Pale, cool skin can also be indicative of decreased perfusion due to cardiac compromise. Given these critical signs and symptoms, the nurse should interpret this as a potential cardiac emergency and initiate immediate interventions aimed at managing and stabilizing the client's condition.

B. The symptoms indicate angina and should be treated as such:

While angina can present with symptoms such as chest pain, it is typically relieved with rest or nitroglycerin. In contrast, the client in this scenario has midsternal chest pain that is not relieved with rest, which is more indicative of an acute coronary event like a myocardial infarction. Therefore, interpreting the symptoms as angina and treating them as such may not be appropriate given the severity and persistence of the chest pain.

C. Treatment should be determined pending the results of an exercise stress test:

Waiting for the results of an exercise stress test is not appropriate in this scenario, as the client's presentation suggests an acute cardiac event that requires immediate intervention. Exercise stress tests are typically used for diagnostic purposes to assess cardiovascular function under controlled conditions but are not suitable for managing acute coronary episodes or emergencies.

D. The symptoms indicate a pulmonary etiology rather than a cardiac etiology:

While some symptoms, such as shortness of breath or chest pain, can overlap between cardiac and pulmonary conditions, the client's presentation with sudden midsternal chest pain unrelieved with rest, pale cool skin, and a history of CAD strongly suggests a cardiac etiology, specifically an acute coronary event. It is essential to prioritize cardiac assessment and intervention based on the client's symptoms and medical history.

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The mother of a teenage boy with sickle cell anemia asks the nurse why her son has such horrible pain during a sickle cell crisis. Which of the following is the best response by the nurse?

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