Situation: Mr. Zapdos is a third semester

Situation: Mr. Zapdos is a third semester nursing student who had an acute medical incident upon arriving for his summer international health experience in La Paz, Bolivia (one of the highest elevation cities on the planet). Almost immediately after disembarking from the plane, Mr. Zapdos began to experience moderate pain on the left side of his abdomen, diarrhea, and vomiting. Believing this to be a GI infection, Mr. Zapdos was seen and treated with Ciprofloxacin by a local MD in La Paz. However, Mr Zapdos’ clinical instructor in La Paz was increasingly worried 24 hrs later when the left-sided abdominal pain was even more severe and the patient was complaining of dizziness, syncope, and dyspnea. The clinical instructor and Mr. Zapdos went to the nearest Emergency Department. Past Medical History: Mr. Zapdos is a 25-year-old male with a history or sickle cell anemia diagnosed during childhood. He takes Hydroxyurea to manage his sickle cell anemia. He was adopted from Greece at the age of 6 months and has lived in Wisconsin with his adopted family for his entire life. His biological parents are both from Greece. His biological father has a history of polycythemia vera. Physical Assessment and Vital Signs from ED: Neuro/Pain: Lethargic but oriented to person, place, time, and situation. Oral Temp 99.7F. Pain is 10/10 in LUQ of abdomen CV/Peripheral Vascular: Sinus tachycardia 123 bpm; 107/68 mm Hg; +1/+1 radial and pedal pulses Respiratory: Breathing appears labored and shortness of breath noted by patient; RR 26 rpm and pulse oximetry is 84% on room air GI: LUQ abdominal tenderness on palpation; hypoactive bowel sounds; last bowel movement was 3 days ago GU: 200mL of urine voided in bedside commode in the past 8 hrs. Amber in color Integumentary: generalized paleness and scattered bruises on arms, legs, and abdomen 1. Which action prescribed by the health care provider will the nurse caring for Mr. Zapdos implement first? A. Give morphine sulfate 4-8 mg IVP every hour as needed B. Administer 100% oxygen using a non-rebreather mask C. Start a 20-gauge peripheral IV line and infuse normal saline at 200mL/hr D. Give pneumococcal and influenza A vaccinations Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: 2. Which of the following factors puts Mr. Zapdos at risk for sickle cell anemia and/or sickle cell crisis? Select all that apply A. Being adopted B. Being of Mediterranean ethnic background C. Being in La Paz, Bolivia D. Growing up in the northern hemisphere E. Having a biological parent with polycythemia vera Circle Answer(s) Above and Include Rationales for Correct and Incorrect Options: 3. The nurse reviews the admission laboratory results and identifies which value as most likely causing Mr. Zapdos’ shortness of breath and respiratory symptoms? A. Leukocyte count of 3,500 B. Hematocrit of 21% C. Platelets 105,000 D. Potassium of 3.3 Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: 4. Which of the following is an accurate list of interventions that would be appropriate to manage Mr. Zapdos’ sickle cell crisis and anemia? Select all that apply F. Initiate a patient-controlled analgesic using hydromorphone G. Apply ice packs to swollen, inflamed joints H. Administer a 1 L bolus of 0.9% normal saline I. Administer immunosuppressants such as cyclosporine J. Administer influenza and pneumococcal vaccinations Circle Answer(s) Above and Include Rationales for Correct and Incorrect Options: Mr. Zapdos is admitted to a medical surgical floor, and he has a sample of blood sent to the lab to assess electrolytes, blood counts, and fluid volume status. Mr. Zapdos also has another set of vital signs taken and another head-to-toe assessment conducted. 5. Mr. Zapdos’ complete blood count labs reveal a current hemoglobin level of 5.0 g/dL. The nurse should anticipate which findings for Mr. Zapdos given this value? A. Crackles in lung bases B. Respiratory depression C. Bradycardia D. Pallor Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: 6. Mr. Zapdos is prescribed 2 units of packed red bloods cells to transfuse as soon as available, but the blood bank is behind schedule. You are told it will take 2 hours before the blood will be available to administer. Mr. Zapdos current vital signs are shown below. Which prescription should the nurse administer first? Blood pressure 91/47 mm Hg Heart rate 152 bpm Oxygen saturation 94% on 3L/min oxygen via nasal cannula Respiratory rate 38 breaths/min Temperature 100.4F (oral) A. IV acetaminophen B. IV normal saline bolus C. IV ondansetron D. IV cefazolin Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: 7. Mr. Zapdos’ units of blood arrive. Which of the following interventions is a priority related to blood administration? A. Written consent must be obtained by RN prior to giving blood B. RN takes vital signs 60 mins prior to administering blood C. RN must remain with patient for the first 15 minutes of blood infusing D. Patient must void prior to beginning blood transfusion Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: 8. Mr. Zapdos is prescribed 2 units of packed red bloods cells to address his anemia. You assess Mr. Zapdos 5 minutes after initiating the blood transfusion. Mr. Zapdos now has a headache, body itching, and chills. You immediately turn off the transfusion and disconnect the tubing at the catheter hub. What action should you take next? A. Monitor electrolytes and urine output B. Change IV tubing at the hub and start normal saline C. Check vital signs every 30 minutes D. Administer intravenous push (IVP) epinephrine Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: 9.Which assessment finding of Mr. Zapdos would require the most immediate intervention (think complications of SCD and sickle cell crisis)? A. Blood work showing anemia B. Small, atrophied spleen C. Right arm weakness and facial droop D. Generalized body and joint pains Circle Only One Answer Above and Include Rationales for Correct and Incorrect Options: 10. Given your assessment finding from 9, which of the following is the priority intervention for definitive diagnosis? A. Obtain a urine sample for culture and sensitivity testing B. Obtain a computer tomography (CT) scan of the head and neck C. Obtain a blood sample to determine lactic acid level D. Conduct a neuromuscular assessment of head, neck, and shoulders please can you explain the right answer and why the wrong one is wrong? i want to compare with what I have. SCIENCE HEALTH SCIENCE NURSING NURS 398

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