Editing Pediatric Nursing – RN Practice Questions (section)

==Question 14==
A 12-year-old with sickle cell disease is admitted in vaso-occlusive crisis. Which prescriptions should the nurse question? '''Select all that apply.'''
# Apply cold packs to the affected joints
# Intravenous fluids at 1.5 times the maintenance rate
# Scheduled morphine by patient-controlled analgesia
# Meperidine every 4 hours as needed for pain
# Oxygen to maintain saturation above 94 percent
# Restrict oral fluids to 500 mL per day

'''Answer:''' 1, 4, and 6.

''Rationale:'' Cold causes vasoconstriction and worsens sickling, so warmth is applied instead. Meperidine is avoided in sickle cell disease because its metabolite normeperidine accumulates and lowers the seizure threshold, particularly with repeated dosing and renal impairment. Fluid restriction promotes sickling; hydration is a cornerstone of crisis management, which is why option 2 is appropriate. Scheduled or patient-controlled opioid analgesia is appropriate because pain in crisis is severe and continuous, and oxygen supports tissue oxygenation.