Ped 4 Brittany Long pre and post test
with explanations
The nurse is caring for a patient with sickle cell anemia who is exhibiting signs of vaso-occlusive crisis.
Which of the following should be included in the plan of care for this patient? (Select all that apply)
a) Assess pain frequently and administer meds routinely
b) Restrict oral fluid intake to decrease stress on the kidneys during crisis
c) Encourage pt to visit with other children in the playroom
d) Administer O2 if saturations are <92% to promote adequate oxygenation
e) Administer hypotonic fluid IV to promote hemodilution
- a) Assess pain frequently and administer meds routinely
d) Administer O2 if saturations are <92% to promote adequate oxygenation
e) Administer hypotonic fluid IV to promote hemodilution
The immediate priorities in the Tx of vaso-occlusive crisis are pain management, adequate hydration, and
administration of O2 to prevent further sickling. Fluid requirements are increased during a crisis, so
increased oral fluid intake should be encouraged in addition to IV fluid replacement using hypotonic
fluids. During the initial management of vaso-occlusive crisis, pain should be assessed frequently and
pain meds given w/a fixed dose on a timed schedule. A quiet environment should be provided to allow the
pt to rest; playing w/ other children in the playroom likely would not be restful. Distraction with music,
TV, or relaxation techniques can be used in addition to pharmacological methods to help manage pain.
The nurse is reviewing lab data on a pt with sickle cell anemia. Which lab findings would indicate the pt
is experiencing a vast-occlusive crisis?
a) increased hgb, decreased platelet, and elevated reticulocyte
b) decreased hgb, decreased platelet, and decreased reticulocyte
c) increased hgb, increased platelet, decreased reticulocyte
d) decreased hgb, increased platelet, greatly elevated reticulocyte - d) decreased hgb, increased platelet,
greatly elevated reticulocyte
, Lab data associated with sickle cell anemia includes decreased hgb, increased platelet, greatly elevated
reticulocyte, and elevated erythrocyte sedimentation rate. Peripheral blood smears will indicate the
presence of sickle-shaped cells.
The nurse is teaching Brittany how to use the FACES scale to rate pain. Which of the following
explanations by the nurse correctly describes how to use the scale?
a) Choose the face that looks like how you feel inside. You don't have to be crying to be hurting a lot
b) I will be able to tell how much pain you are in by asking your mom and watching how you behave
c) Look at the pictures and choose the face that looks the most like you
d)Pick a number 0-5 with 0 meaning no pain and 5 meaning severe pain - a) Choose the face that looks
like how you feel inside. You don't have to be crying to be hurting a lot
The FACES pain rating scale is a self-report tool that is acceptable for use w/ a developmentally
appropriate 5 y/o. To use the tool, the pt is asked to choose the face that most closely resembles how he or
she feels. During the initial health hx & assessment, the nurse should ask which words the pt uses to
describe pain and use those terms when assessing the pt's pain level. It is important to reinforce that the pt
doesn't have to actually look like the face bc the scale intended to show how he or she is feeling versus his
or her behavior.
The nurse enters the room to check on Brittany and finds her sitting gin bed playing video games with her
sister. VS: Temp, 37.4 C oral; HR 120 bpm; RR 26 bpm; BP 100/60 mmHg; & SpO2 97%. She rates her
pain as a 5/5 on the FACES scale. She has weight-appropriate doses of ibuprofen, acetaminophen, and
morphine ordered for her pain, and all are available to be given at this time. What would be the most
appropriate med for the nurse to administer?
a) Ibuprofen bc the pt is exhibiting signs of mild pain
b) Acetaminophen bc the pt is not exhibiting signs of severe pain
c) Morphine bc the pt reports severe pain
d) Nothing bc the pt's behavior doesn't indicate signs of pain - c) Morphine bc the pt reports severe pain
The pr self-reports pain 5/5 on the FACES pain scale, which indicates severe pain, and thus should be
medicated with and opioid analgesic; morphine is the gold standard opioid agonist and drug of choice for
severe pain. The pt's behavior and external signs are not as accurate as the self-report scale for indicating
pain
with explanations
The nurse is caring for a patient with sickle cell anemia who is exhibiting signs of vaso-occlusive crisis.
Which of the following should be included in the plan of care for this patient? (Select all that apply)
a) Assess pain frequently and administer meds routinely
b) Restrict oral fluid intake to decrease stress on the kidneys during crisis
c) Encourage pt to visit with other children in the playroom
d) Administer O2 if saturations are <92% to promote adequate oxygenation
e) Administer hypotonic fluid IV to promote hemodilution
- a) Assess pain frequently and administer meds routinely
d) Administer O2 if saturations are <92% to promote adequate oxygenation
e) Administer hypotonic fluid IV to promote hemodilution
The immediate priorities in the Tx of vaso-occlusive crisis are pain management, adequate hydration, and
administration of O2 to prevent further sickling. Fluid requirements are increased during a crisis, so
increased oral fluid intake should be encouraged in addition to IV fluid replacement using hypotonic
fluids. During the initial management of vaso-occlusive crisis, pain should be assessed frequently and
pain meds given w/a fixed dose on a timed schedule. A quiet environment should be provided to allow the
pt to rest; playing w/ other children in the playroom likely would not be restful. Distraction with music,
TV, or relaxation techniques can be used in addition to pharmacological methods to help manage pain.
The nurse is reviewing lab data on a pt with sickle cell anemia. Which lab findings would indicate the pt
is experiencing a vast-occlusive crisis?
a) increased hgb, decreased platelet, and elevated reticulocyte
b) decreased hgb, decreased platelet, and decreased reticulocyte
c) increased hgb, increased platelet, decreased reticulocyte
d) decreased hgb, increased platelet, greatly elevated reticulocyte - d) decreased hgb, increased platelet,
greatly elevated reticulocyte
, Lab data associated with sickle cell anemia includes decreased hgb, increased platelet, greatly elevated
reticulocyte, and elevated erythrocyte sedimentation rate. Peripheral blood smears will indicate the
presence of sickle-shaped cells.
The nurse is teaching Brittany how to use the FACES scale to rate pain. Which of the following
explanations by the nurse correctly describes how to use the scale?
a) Choose the face that looks like how you feel inside. You don't have to be crying to be hurting a lot
b) I will be able to tell how much pain you are in by asking your mom and watching how you behave
c) Look at the pictures and choose the face that looks the most like you
d)Pick a number 0-5 with 0 meaning no pain and 5 meaning severe pain - a) Choose the face that looks
like how you feel inside. You don't have to be crying to be hurting a lot
The FACES pain rating scale is a self-report tool that is acceptable for use w/ a developmentally
appropriate 5 y/o. To use the tool, the pt is asked to choose the face that most closely resembles how he or
she feels. During the initial health hx & assessment, the nurse should ask which words the pt uses to
describe pain and use those terms when assessing the pt's pain level. It is important to reinforce that the pt
doesn't have to actually look like the face bc the scale intended to show how he or she is feeling versus his
or her behavior.
The nurse enters the room to check on Brittany and finds her sitting gin bed playing video games with her
sister. VS: Temp, 37.4 C oral; HR 120 bpm; RR 26 bpm; BP 100/60 mmHg; & SpO2 97%. She rates her
pain as a 5/5 on the FACES scale. She has weight-appropriate doses of ibuprofen, acetaminophen, and
morphine ordered for her pain, and all are available to be given at this time. What would be the most
appropriate med for the nurse to administer?
a) Ibuprofen bc the pt is exhibiting signs of mild pain
b) Acetaminophen bc the pt is not exhibiting signs of severe pain
c) Morphine bc the pt reports severe pain
d) Nothing bc the pt's behavior doesn't indicate signs of pain - c) Morphine bc the pt reports severe pain
The pr self-reports pain 5/5 on the FACES pain scale, which indicates severe pain, and thus should be
medicated with and opioid analgesic; morphine is the gold standard opioid agonist and drug of choice for
severe pain. The pt's behavior and external signs are not as accurate as the self-report scale for indicating
pain
