A client with sickle cell disease (SCD) takes hydroxyurea ...

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A client with sickle cell disease (SCD) takes hydroxyurea (Droxia). The client presents to the clinic reporting an increase in fatigue. What laboratory result should the nurse report immediately?
 
  a. Hematocrit: 25
  b. Hemoglobin: 9.2 mg/dL
  c. Potassium: 3.2 mEq/L
  d. White blood cell count: 38,000/mm3

Question 2

A client has a sickle cell crisis with extreme lower extremity pain. What comfort measure does the nurse delegate to the unlicensed assistive personnel (UAP)?
 
  a. Apply ice packs to the client's legs.
  b. Elevate the client's legs on pillows.
  c. Keep the lower extremities warm.
  d. Place elastic bandage wraps on the client's legs.

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Answer to Question 1

ANS: D
Although individuals with SCD often have elevated white blood cell (WBC) counts, this extreme elevation could indicate leukemia, a complication of taking hydroxyurea. The nurse should report this finding immediately. Alternatively, it could indicate infection, a serious problem for clients with SCD. Hematocrit and hemoglobin levels are normally low in people with SCD. The potassium level, while slightly low, is not as worrisome as the WBCs.

Answer to Question 2

ANS: C
During a sickle cell crisis, the tissue distal to the occlusion has decreased blood flow and ischemia, leading to pain. Due to decreased blood flow, the client's legs will be cool or cold. The UAP can attempt to keep the client's legs warm. Ice and elevation will further decrease perfusion. Elastic bandage wraps are not indicated and may constrict perfusion in the legs.

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TYSM

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Excellent