Page 917 - Saunders Comprehensive Review For NCLEX-RN

anxiety, tremors, myoclonus, and generalized seizures when it accumulates with
repetitive dosing. The nurse would question the prescription for restricted fluids and
meperidine for pain control. Positioning for comfort, avoiding strain on painful
joints, oxygen, and a high-calorie and high-protein diet are also important parts of
the treatment plan.
Test-Taking Strategy: Focus on the subject, identifying the prescriptions that need
to be questioned and on the pathophysiology that occurs in sickle cell disease.
Recalling that fluids are an important component of the treatment plan will assist in
identifying that a fluid restriction prescription would need to be questioned. Also,
recalling the effects of meperidine will assist in identifying that this prescription
needs to be questioned.
Level of Cognitive Ability: Analyzing
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process—Implementation
Content Area: Pediatrics: Hematological
Health Problem: Pediatric-Specific: Anemias
Priority Concepts: Collaboration; Safety
Reference: McKinney et al. (2018), pp. 1125-1127.

311. Answer: 1, 2, 3, 4, 6

Rationale: von Willebrand’s disease is a hereditary bleeding disorder
characterized by a deficiency of or a defect in a protein termed von Willebrand factor.
The disorder causes platelets to adhere to damaged endothelium. It is characterized
by an increased tendency to bleed from mucous membranes. Assessment findings
include epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding.
An elevated creatinine level is not associated with this disorder.
Test-Taking Strategy: Focus on the subject, assessment findings, and on the
child’s diagnosis. Recalling that this disorder is characterized by an increased
tendency to bleed from mucous membranes will direct you to the correct options.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pediatrics: Hematological
Health Problem: Pediatric-Specific: Bleeding Disorders
Priority Concepts: Clinical Judgment; Clotting
Reference: McKinney et al. (2018), pp. 1132-1133.

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