A 32-year-old client with a history of sickle cell anemia is admitted to the hospital during a sickle cell crisis. The physician orders all of these interventions. Which order will you implement first?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Start a large-gauge IV line and infuse normal saline at 200 mL/hour. The priority in managing a sickle cell crisis is to improve hydration and perfusion to prevent further sickling of red blood cells, vaso-occlusion, and tissue damage. By starting a large-gauge IV line and infusing normal saline, you are ensuring adequate hydration which helps to improve blood flow and oxygen delivery to tissues, thus mitigating the crisis. Option A, giving morphine sulfate, is important for pain management but addressing hydration and perfusion takes precedence in this situation. Option C, immunizations, and Option D, oxygen administration, are important interventions but do not directly address the immediate need for hydration and perfusion. Educationally, this question highlights the critical thinking required in prioritizing nursing interventions during a sickle cell crisis. Understanding the pathophysiology of sickle cell anemia and the importance of hydration in managing a crisis is crucial for providing safe and effective care to these patients.

Correct Answer: B

Rationale: In this scenario, the immediate intervention required as the charge nurse is option B, where the LPN positions cold packs on the client's knees. This action is contraindicated in sickle cell crisis as cold can exacerbate vaso-occlusive pain and potentially worsen the client's condition. Option A is not the immediate concern as encouraging the client to use the ordered PCA (patient-controlled analgesia) is appropriate for managing severe pain in a sickle cell crisis. Option C, placing a 'No Visitors' sign, is not urgent and can be addressed later based on the client's condition and hospital policy. Option D, checking the client's temperature every 2 hours, is a routine nursing task and does not require immediate intervention in this situation. Educationally, this question highlights the importance of understanding the specific care needs of clients with sickle cell crisis. It emphasizes the need for nurses to have knowledge of appropriate interventions and contraindications to ensure safe and effective care for these patients. This scenario also underscores the significance of prompt intervention in critical situations to prevent potential harm to the client.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Transfuse Factor VII concentrate. The priority in a client with hemophilia A, a disorder where there is a deficiency in factor VIII, is to address the bleeding risk. Factor VII concentrate helps replace the deficient clotting factor, aiding in hemostasis and preventing further bleeding complications. This intervention is crucial in managing hemophilia-related bleeding, especially in the setting of a traumatic injury like a car accident. Option A) Transport to radiology for C-spine x-rays is not the priority as assessing the C-spine can wait until the bleeding risk is addressed. Option C) Type and cross-match for 4 units RBCs is not the priority as addressing the clotting factor deficiency takes precedence over potential blood transfusions. Option D) Infuse normal saline at 250 mL/hour is not the priority as it does not address the underlying issue of hemophilia and bleeding risk. Educationally, this question highlights the importance of prioritizing interventions based on the client's condition, emphasizing the critical nature of addressing the underlying pathophysiology in emergencies. Understanding the specific management strategies for clients with hemophilia is essential in providing safe and effective care in emergency situations.

Correct Answer: C

Rationale: The correct answer is C) The client's oxygen saturation is 87%. In a client with disseminated intravascular coagulation (DIC) associated with a gram-negative infection, a low oxygen saturation level of 87% indicates hypoxemia, which is a critical situation requiring immediate intervention. Hypoxemia can lead to tissue hypoxia, worsening the coagulation abnormalities in DIC. Therefore, addressing the oxygen saturation level is a priority to prevent further complications. Option A) There is no palpable radial or pedal pulse may suggest impaired circulation but does not address the immediate threat of hypoxemia in this scenario. Option B) The client complains of chest pain is concerning for a possible cardiac event, but hypoxemia takes precedence in the context of DIC and a gram-negative infection. Option D) There is mottling of the hands and feet is indicative of poor perfusion, which is important but not as immediately critical as addressing hypoxemia in this situation. In an educational context, understanding prioritization of care based on the client's condition is crucial for nurses, especially when dealing with complex conditions like DIC. Recognizing and addressing the most critical assessment findings promptly can significantly impact patient outcomes.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) A 69-year-old with chemotherapy-induced neutropenia who has an elevated oral temperature. This client should be assessed first because neutropenia (low white blood cell count) puts them at high risk for infections, and an elevated temperature could indicate the presence of an infection, which is a medical emergency in this case. Option A, the 26-year-old with thalassemia major, is stable and scheduled for a blood transfusion, which is not an immediate concern. Option B, the 44-year-old with sickle cell crisis awaiting a CT scan, is also stable for the moment and can wait for assessment. Option C, the 50-year-old with non-Hodgkin's lymphoma expressing emotional distress, while important, does not present an immediate physiological threat that requires urgent assessment compared to the risk of infection in the neutropenic patient. Educationally, this question highlights the importance of prioritizing patient care based on the urgency of the situation and the potential risks involved. It reinforces the significance of recognizing signs of infection in immunocompromised patients and the need for prompt assessment and intervention in such cases to prevent further complications.