Practice Question
The nurse is admitting a 6-year-old child with Sickle Cell Anemia who is being admitted for vaso-occlusive crisis.
Answer Choices:
Rationale:
✅ 1. Monitor RLE pulses with vital signs — Anticipated
🦵 In a vaso-occlusive crisis (VOC), pain and inflammation are commonly localized in the long bones or joints, as seen here in the right lower extremity (RLE).
🦵 Monitoring distal pulses ensures that tissue perfusion remains intact and helps detect early signs of compartment syndrome or severe ischemia.
🦵 Although the RLE is warm, tender, and pulse strength is currently intact, VOC can worsen rapidly and monitoring is critical.
🦵 Including RLE pulse checks with routine vital signs helps track changes and ensure timely response to perfusion threats.
🦵 Neurovascular assessment is essential, especially in the context of repeated VOCs or increasing severity, as reported by the parent.
✅ 2. Administer Oxycodone 3 mg Q3–4 hours PRN for pain — Anticipated
💊 Severe pain is the hallmark of a vaso-occlusive crisis due to ischemia from sickled red cells occluding vessels.
💊 The child’s pain rating is 10/10 using the FACES scale, indicating the need for effective analgesia.
💊 The child uses oxycodone at home and received 3 mg PO in the ER, demonstrating it is a safe and established regimen.
💊 PRN dosing every 3–4 hours is appropriate for breakthrough pain management and aligns with the child’s chronic pain regimen.
💊 Prompt and adequate pain control also reduces physiologic stress, improves oxygenation, and minimizes complications.
✅ 3. Continue IV NSS @ 67 mL/hour — Anticipated
💧 Hydration is a cornerstone treatment in VOC to reduce blood viscosity and improve circulation of red blood cells.
💧 The child was already started on a 20 mL/kg bolus followed by maintenance fluids at 67 mL/hr, based on weight.
💧 Continued IV fluid administration promotes rehydration and helps prevent further sickling of RBCs.
💧 Normal saline is preferred for hydration in sickle cell patients because it does not contain glucose, which could worsen dehydration.
💧 Care must be taken to avoid fluid overload, but maintenance hydration at this rate is standard.
❌ 4. Decrease O₂ to 2 L/min — Contraindicated
🫁 The child is in active VOC with pain, increased respiratory rate, and hypoxia risk, and is already receiving O₂ at 4 L/min via nasal cannula.
🫁 Oxygen administration helps reduce hypoxia-induced sickling, especially during crises.
🫁 Decreasing oxygen too early may exacerbate sickling and compromise tissue oxygen delivery.
🫁 Since the child is in distress and had ongoing respiratory signs (e.g., shallow breathing, high pain level), oxygen must be maintained until clinical improvement and labs confirm stability.
🫁 Tapering oxygen should be guided by O₂ saturation levels, respiratory assessment, and MD orders — not done preemptively.
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This question is from RN ATI Pediatrics Nurs 243 Exam which contains 33 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Pediatrics
- Answer Choices: 0