Ped v Sim Brittany Long Pre Post Quiz PDF

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1 The nurse is caring for a patient weighing 16 kg with an order to administer acetaminophen (Tylenol) for acute pain crisis. The safe dosage range for children is 10 to 15 mg/kg/dose. What is the maximum safe dose for this patient in milligrams?__________________________ Time Spent - 00:01:44 Your Response: 240 Rationale: To determine the maximum safe dose for this patient, multiply the high end of the dosage range by the patient's weight in kilograms: 15 × 16 = 240. Thus, the maximum safe dose is 240 mg. 2A 5-year-old patient with sickle cell anemia has an order for oral codeine elixir 8 mg every 4 hours around the clock for pain. Which of the following methods is most appropriate for the nurse to employ to administer the medication? Time Spent - 00:00:43 Your Response: Place medication in an oral syringe and allow the patient to squirt into his or her mouth Rationale: The preschool-aged or young school-aged child may enjoy using an oral syringe to squirt medication into his or her mouth; it is engaging and gives them a sense of control. A dropper is appropriate for use with infants and younger children; older children can take oral medication from a medicine cup or measured medicine spoon. Medication should be placed in the posterior side of the patient's cheek and should be given slowly in small amounts, allowing the patient to swallow before placing more medication into the mouth. In order to maintain trust, it is important to tell children if there is medication mixed into food. 3A nurse is explaining the pathophysiology of vaso-occlusive pain crisis to the parent of a patient with sickle cell anemia. Which of the following explanations by the nurse is correct? Time Spent - 00:00:19 Your Response: Sickled cells clump together and cause the blood to become thicker, preventing blood flow through smaller vessels, causing decreased oxygenation and increased pain in the affected area. Rationale: Sickle cell vaso-occlusive pain crisis occurs when sickled cells clump in the microvasculature, impeding blood flow (not increasing it), causing local tissue hypoxia, which progresses to ischemia, resulting in severe pain as circulation to the affected area decreases. Bone marrow suppression and immune system depression are not involved in the pathophysiology of vaso-occlusive pain crisis. 4A nurse is assessing the pain level of a 5-year-old patient hospitalized with vaso-occlusive pain crisis. Which of the following would be the best scale to use with this patient? Time Spent - 00:00:06

Your Response: FACES scale Rationale: The FACES pain rating scale is a self-report tool that is acceptable for use with a developmentally appropriate 5-year-old. Visual analog and numeric scales are for use with patients over 7 or 8 years of age. The FLACC behavioral scale is appropriate for when the patient cannot accurately report his or her own level of pain due to age or developmental level. 5A patient with sickle cell disease experiencing a vaso-occlusive crisis comes to the emergency room for evaluation. Which of the following are acute manifestations of this disease that the nurse should expect to see in this patient? Time Spent - 00:00:13 Your Response: Acute leg pain and dactylitis Rationale: Acute manifestations of sickle cell anemia in a vaso-occlusive crisis include pain crisis and swelling of the fingers and toes (dactylitis). Hypertension and tachycardia are often associated with acute pain. Anemia, jaundice, enuresis, and proteinuria are chronic manifestations of sickle cell anemia. 6During the nurse's initial assessment of a 5-year-old admitted with vaso-occlusive crisis, the patient reports a pain level of 4 on the FACES scale. The patient is lying quietly in bed watching television. Which of the following should the nurse do? Time Spent - 00:00:38 Your Response: Administer the prescribed analgesic as ordered Rationale: The FACES pain rating scale is a self-report tool that can be used by children as young as 3 years of age. A 5-year-old is old enough to accurately report his or her own pain level and may be lying still as a coping strategy or because movement is painful. Resting quietly or sleeping may be a coping strategy for the patient when experiencing pain or may reflect exhaustion in the patient who is coping with pain. 7The nurse is performing a physical assessment on a 5-year-old patient. Which of the following demonstrates that the nurse understands developmentally appropriate communication? Time Spent - 00:00:40 Your Response: I want to listen to you breathe. I need you to help me hold my stethoscope in place. Rationale: Preschoolers should be given a job during the assessment process, such as holding the stethoscope or pen light. The nurse should avoid using confusing terms such as temperature, blood pressure, or test. Instead, the nurse should say, "Let's see how warm you are," or "I want to listen to you breathe." When assessing a preschool-aged patient, the patient can sit in the caregiver's lap or sit on the exam table within reach and eye contact of the caregiver. Children should never be forced to change into a gown. It is important to allow children to stay in their own clothing and to wear shorts or underwear under a gown if preferred.

8 A 5-year-old comes to the emergency room with a history of sickle cell anemia and acute leg pain. When obtaining the health history, the nurse should include questions related to which of the following? (Select all that apply.) Time Spent - 00:00:28 Your Response: Immunization history, Precipitating events, Past hospitalizations and treatment, Frequency of vaso-occlusive crises Rationale: When obtaining a health history on a patient with sickle cell anemia, the nurse should elicit information related to growth and development, frequency and extent of vaso-occlusive crises, past hospitalizations and treatment for pain crises, immunization status, history of blood transfusions, current medication regimen, and precipitating events. A family history of blood transfusions would not be relevant, as it would not affect the patient. 9A nurse is caring for pediatric patient who was recently diagnosed with sickle cell anemia. The patient's mother says, "I don't understand how one of my children contracted this disease when the other doesn't have it." Which of the following would be the best response by the nurse? Time Spent - 00:00:40 Your Response: Both parents have the sickle cell trait, and your risk for having a child with sickle cell anemia is 25% with each pregnancy. Rationale: Sickle cell anemia is an autosomal recessive disorder; both parents must have the trait for a child to have the disease. With each pregnancy, there is a 25% chance the child will have sickle cell anemia, a 50% chance the child will be a carrier of the trait, and a 25% chance the child will be unaffected. Post Quiz 1After the nurse has given discharge instructions regarding prevention of vaso-occlusive pain crises, which response by Brittany's mother indicates that further teaching is needed? Time Spent - 00:00:18 Your Response: Drinking too much water can trigger another crisis. Rationale: Trauma, stress, illness, dehydration, and severe temperature changes are all factors in vaso-occlusive crises; fluid overload is not a trigger. 2 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.) Time Spent - 00:00:28

Your Response: Administer hypotonic fluids intravenously to promote hemodilution, Assess pain frequently and administer medications routinely, Administer oxygen if saturations are less than 92% to promote adequate oxygenation Rationale: The immediate priorities in the treatment of vaso-occlusive crisis are pain management, adequate hydration, and administration of oxygen to prevent further sickling. Fluid requirements are increased during a crisis, so increased oral fluid intake should be encouraged in addition to intravenous fluid replacement using hypotonic fluids. During the initial management of vaso-occlusive crisis, pain should be assessed frequently and pain medications given with a fixed dose on a timed schedule. A quiet environment should be provided to allow the patient to rest; playing with other children in the playroom likely would not be restful. Distraction with music, television, or relaxation techniques can be used in addition to pharmacological methods to help manage pain. 3A nurse is caring for a patient with sickle cell anemia exhibiting signs of vaso-occlusive crisis. Which of the following would be the highest priority and most appropriate nursing diagnosis in this case? Time Spent - 00:00:17 Your Response: Acute pain related to tissue ischemia Rationale: Treatment of sickle cell crisis focuses on pain management. Thus, the diagnoses pertaining to fatigue, impaired mobility, and anxiety would be of lower priority than that of acute pain. 4The 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? Time Spent - 00:00:34 Your Response: Choose the face that looks like how you feel inside. You don't have to be crying to be hurting a lot. Rationale: The FACES pain rating scale is a self-report tool that is acceptable for use with a developmentally appropriate 5-year-old. To use the tool, the patient is asked to choose the face that most closely resembles how he or she feels. During the initial health history and assessment, the nurse should ask which words the patient uses to describe pain (e.g., hurt, owie, boo boo) and use those terms when assessing the patient's pain level. It is important to reinforce that the patient does not have to actually look like the face (i.e., frowning, crying, etc.) because the scale is intended to show how he or she is feeling versus his or her behavior. 5The nurse enters the room to check on Brittany and finds her sitting in bed playing video games with her sister. Vital signs are as follows: temperature, 37.4°C oral; heart rate, 102 beats per minute; respiratory rate, 26 breaths per minute; blood pressure, 100/60 mm Hg; and oxygen saturation, 97%. She rates her pain as 5 out of 5 on the FACES scale. She has weight-appropriate doses of ibuprofen, acetaminophen, and morphine ordered for pain, and all are available to be given at this time. What would be the most appropriate medication for the nurse to administer?

Time Spent - 00:00:55 Your Response: Morphine because the patient reports severe pain Rationale: The patient self-reports pain of 5 out of 5 on the FACES pain scale, which indicates severe pain, and thus should be medicated with an opioid analgesic; morphine is the gold standard opioid agonist and drug of choice for severe pain. The patient's behavior and external signs are not as accurate as the self-report pain scale for indicating pain. 6Brittany has been receiving intravenous morphine for pain associated with a vaso-occlusive crisis for 1 week. She has been having increased pain and, based on follow-up pain assessment scores, the morphine is not as effective as it was initially. The provider has increased the morphine dose, but her mother voices concerns that Brittany is addicted to the medication. Which of the following responses by the nurse is correct? Time Spent - 00:00:30 Your Response: Over time, drug tolerance occurs, requiring higher doses of morphine to relieve Brittany's pain. Tolerance is not addiction. Rationale: Brittany is demonstrating drug tolerance, which is different from physical dependence, or addiction. Drug tolerance occurs when increasing doses of medication are required to manage pain. Physical dependence, which can occur after as few as 5 days of continuous medication use, is a perceived need by the patient to continue taking the drug to prevent symptoms of withdrawal, which can occur if suddenly stopped. Addiction to narcotics when used to treat children's pain is very rare but does occur. Meperidine is not recommended for pain relief in children, as severe side effects such as seizures are associated with use. 7A patient came to the emergency room with acute pain crisis secondary to sickle cell anemia. The patient received morphine sulfate intravenously 1 hour ago for severe pain and is awake, alert, and complaining of generalized itching. On inspection, the patient's skin is flat and without erythema. What action should the nurse take? Time Spent - 00:00:54 Your Response: Call the provider and request an order for a medication for the itching as needed. Rationale: Itching (pruritus) is a common side effect of opiate medications. Antipruritic medications can be prescribed to manage itching, and stopping administration of the morphine is not indicated. Naloxone would be used to reverse the effects of the opioid in the case of respiratory depression, which is not needed in this case because this patient is awake and alert. Urticaria may indicate that the patient is experiencing an allergic reaction to the medication and should be reported to the provider, but this is not occurring in this case, as the patient's skin is flat and without erythema. 8The nurse is reviewing laboratory data on a patient with sickle cell anemia. Which laboratory findings would indicate the patient is experiencing a vaso-occlusive crisis?

Time Spent - 00:00:35 Your Response: Decreased hemoglobin, increased platelet count, and greatly elevated reticulocyte count Rationale: Laboratory data associated with sickle cell anemia includes decreased hemoglobin, greatly elevated reticulocyte count, increased platelet count, and elevated erythrocyte sedimentation rate. Peripheral blood smears will indicate the presence of sickle-shaped cells. 9 The nurse is caring for 5-year-old Brittany, who was admitted with vaso-occlusive pain crisis and is reporting pain in her leg. In addition to pharmacologic pain management, what nonpharmacologic pain management strategies can the nurse use for this patient? (Select all that apply.) Time Spent - 00:00:36 Your Response: Place a heating pad on the patient's leg and have her mother read her a story., Encourage deep breathing by having the patient blow bubbles., Offer the patient a favorite stuffed toy and distract her by asking about the animal. Rationale: Management of sickle cell crisis is aimed at managing pain and promoting circulation. Deep breathing, application of heat, and offering a toy are all effective ways of managing pain. Immobilization, pressure, and cool compresses cause vasoconstriction and can impede blood flow, which is contraindicated in sickle cell crisis. Family members should be encouraged to stay at the bedside to offer comfort and help to minimize the stressors of hospitalization. 10While the nurse assesses Brittany, her mother questions why the nurse is checking the patient's heart and lungs when the admitting complaint was leg pain. The nurse is assessing Brittany for which of the following complications of vaso-occlusive crisis? Time Spent - 00:00:25 Your Response: Chest syndrome Rationale: Acute chest syndrome is caused by the clumping of sickled cells in the lungs, which results in decreased gas exchange, producing hypoxia, and further sickling. Pneumothorax, or collection of air in the pleural space, is not associated with vaso-occlusive crisis. Splenomegaly, or enlargement of the spleen, is another complication of vaso-occlusive crisis that occurs when blood is sequestered in the spleen; however, this would warrant assessment of the abdomen, not the heart and lungs. Dactylitis, another complication, is swelling of the fingers and toes....