ch. 25 PrepU

The nurse is caring for a client who is in a sickle cell crisis. The child is hospitalized for pain management during the crisis. The parents tell the nurse that they do not think their child needs any pain medication because the child is sleeping a lot. How should the nurse respond? "I agree. Since your child is sleeping the pain must not be too severe. I will hold his pain medication." "The pain medication is prescribed on a routine basis to keep the pain under control, so I have to give it as prescribed." "We need to wait for your child to express the pain level to us before providing medication." "I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."

"I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."

A nurse is providing teaching on safety to a group of parents whose children are diagnosed with hemophilia. Which statement made by a parent requires follow-up by the nurse? "Our child has a medical alert bracelet that is worn at all times." "We make sure our toddler wears a helmet and knee pads." "We had a trampoline but got rid of it after our child was diagnosed." "Our child always wears a helmet and body padding when playing football."

"Our child always wears a helmet and body padding when playing football."

The nurse is caring for a child with hemophilia. The parents are upset by the possibility that the child will become infected with hepatitis from the clotting factor replacement therapy. Which response by the nurse would be appropriate? "The use of dry heat sterilization has proven to inactivate hepatitis virus, resulting to zero factors transfusion-related incidence of hepatitis infection." "Parents commonly fear the worst; however, the factor will help your child lead a normal life." "There are risks with any treatment including using blood products, but these are very minor." "Although factor replacement is expensive, there's more financial strain from missing work if your child has a bleeding episode."

"The use of dry heat sterilization has proven to inactivate hepatitis virus, resulting to zero factors transfusion-related incidence of hepatitis infection."

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? "We should administer desmopressin as often as needed." "We should be aware that she may suffer from menorrhagia." "We understand that she may have frequent nosebleeds." "We need to administer Stimate (desmopressin) prior to dental work."

"We should administer desmopressin as often as needed."

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? 130 ml/kg of fluids per day 150 ml/kg of fluids 110 ml/kg of fluids 120 ml/kg of fluids per day

150 ml/kg of fluids

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. Administering analgesics Promoting exercise and activity Administering platelets Administering oxygen Maintaining fluid intake

Administering oxygen Administering analgesics Maintaining fluid intake

A child is hospitalized with complications related to hemophilia. The health care provider has discussed the child's plan of care with the parents, but they continue to ask questions. What action will the nurse take? Answer the parents' questions as completely as possible. Notify the health care provider that the parents still have questions. Reassure the parents that they have been fully briefed on their child's treatment. Encourage the parents to focus their attention on their child.

Answer the parents' questions as completely as possible.

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? Elevate the injured area such as a leg or arm. Apply direct pressure to the area. Apply heat to the site of bleeding. Administer factor VIII replacement.

Apply heat to the site of bleeding.

A nurse is providing care to a child with thalassemia major. The nurse understands that cure of the disorder is achieved with which treatment? Splenectomy Oral iron chelating agents Hypertransfusion therapy Bone marrow stem cell transplant

Bone marrow stem cell transplant

A health care provider has prescribed hydroxyurea 650 mg for a child diagnosed with sickle cell anemia. The child weighs 65 lb (29.5 kg). The normal recommended dose is 20 mg/kg/day. What action should the nurse take? Contact the health care provider to lower the dose. Contact the health care provider to increase the dose. Call the pharmacist to clarify the dosage. Administer the medication as prescribed.

Contact the health care provider to lower the dose.

A child with hemophilia A has had repeated episodes of hemarthrosis. Which assessment finding is most important to consider? Increased muscle strength Enlargement of the joint space Decreased range of motion Increased cartilage formation

Decreased range of motion

A child is hospitalized with a diagnosis of aplastic anemia. The child is scheduled to have a blood transfusion. As the nurse explains the plan of care to the child and family, the child starts to cry. What is the best action for the nurse to take next? Enlist the help of the child-life specialist to explain the procedure to the child. Tell the parent they will be able to hold the child during the transfusion. Tell the child there is nothing to be afraid of because the transfusion will not hurt. Leave the room long enough to give the child time to settle down.

Enlist the help of the child-life specialist to explain the procedure to the child.

When providing care for a toddler with hemophilia who is being prepped for an elective procedure, which nursing action is priority? Ensure all side rails are padded. Assess blood pressures frequently. Provide education to avoid sports. Administer acetaminophen orally.

Ensure all side rails are padded.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Monitor daily complete blood count (CBC). Ensure neutropenic precautions are in place. Encourage therapeutic play activities. Remind parents to contact the child's school.

Ensure neutropenic precautions are in place.

While administering a blood transfusion to a child with a hematologic disorder, the nurse notes the child develops urticaria and wheezing. Which collaborative interventions will the nurse begin? Select all that apply. Obtain a blood culture. Apply oxygen as needed. Administer a diuretic. Discontinue the transfusion. Give an antihistamine.

Give an antihistamine. Apply oxygen as needed. Discontinue the transfusion.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client? Do not allow a dressing to be applied postoperatively. Mark the client's chart to receive no analgesia. Handle the child gently when transferring to a stretcher. Caution the child not to brush the teeth before surgery.

Handle the child gently when transferring to a stretcher.

A parent has just learned that the infant has sickle cell anemia. The parent expressed concern that the disorder was something that could have been prevented. What is the best action for the nurse to take? Tell the parent that there was nothing he or she could have done to prevent it. Have a discussion with the parent regarding the etiology of the disorder. Explain that it is normal to want to learn how the disorder could happen. Provide written material on the disorder and answer any questions the parent may have.

Have a discussion with the parent regarding the etiology of the disorder.

The nurse is caring for a 12-year-old boy with sickle cell disease. During a routine wellness exam, his mother tells the nurse that the boy is becoming rebellious. He responds by telling the nurse that it's because "she never lets me out of her sight!" Which of the following would be most effective in promoting the best outcome for the child and family? Advise the mother that she needs to give him freedom. Remind him that he needs to take responsibility for his health. Encourage them to join a support group. Tell them about a camp for children with sickle cell disease and their parents.

Tell them about a camp for children with sickle cell disease and their parents.

In caring for a child with sickle cell disease, the highest priority goal is: the caregiver's anxiety will be reduced. the child's skin integrity will be maintained. The child's fluid intake will improve. the family will verbalize understanding of the disease crisis.

The child's fluid intake will improve.

The nurse is caring for a pediatric client experiencing mild to moderate pain related to a recent bone marrow biopsy procedure. The child is receiving chemotherapy treatments for a cancer diagnosis. The child has several p.r.n. pain medication options on the medication administration record. Which medication should the nurse administer? fentanyl acetaminophen morphine naproxen

acetaminophen

A 12-year-old child is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse has completed an assessment and is creating a plan of care. What aspect of the plan of care is most important to the client's outcome? maintain the hemoglobin level at 10 g/dL (100 g/L) analgesics administered on a set schedule instead of as needed increasing the daily fluid intake age-appropriate distractions as a pain-relief strategy

increasing the daily fluid intake

An 11-year-old child is being prepared for discharge after experiencing a vasoocclusive crisis secondary to sickle cell disease. The child has been prescribed hydroxyurea. After teaching the child and parents about this medication, the nurse determines that the teaching was successful when the parents identify that they will notify the health care provider about which condition? constipation gastric upset headache infection

infection

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia. The child's condition has improved, and the child is much more active and eager to play. Which toy should the nurse offer the child? squeaky toy fabric books board games large piece puzzle

large piece puzzle

The nurse is performing a respiratory assessment on a black adolescent experiencing a sickle-cell crisis. Where is the best place for the nurse to check for cyanosis on this client? nail beds lips mucous membranes cheeks

mucous membranes

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? Administer meperidine as ordered. Initiate pain assessment with a standardized pain scale. Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. Use guided imagery and therapeutic touch.

Initiate pain assessment with a standardized pain scale.

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results? lack of fasting for 12 hours blood transfusion 1 month ago use of iron supplementation history of recent infection

blood transfusion 1 month ago

When caring for a 7-year-old client diagnosed with sickle cell anemia, which clinical manifestation will the nurse report to the health care provider first? hemoglobin level of 10 g/dl (100 g/L) respiratory rate 23 breaths/min facial droop dactylitis of the hands and feet

facial droop

An 11-year-old male is diagnosed with mild hemophilia. Upon review of the child's factor assay, the nurse identifies which factor level for this category of hemophilia? factor level less than 1% factor level of 5% to 50% factor level greater than 50% factor level of 1% to 5%

factor level of 5% to 50%

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? "We should call the doctor for any fever over 100°F (37.8°C)." "We must watch for unusual headache, loss of feeling, or sudden weakness." "We need to seek medical attention for abdominal pain." "We must be compliant with vaccinations and prophylactic penicillin."

"We should call the doctor for any fever over 100°F (37.8°C)."

A nurse is caring for a 7-year-old child with hemophilia who requires an infusion of factor VIII. The child is fearful about the process and is resisting treatment. How should the nurse respond? "Will you help me apply this adhesive bandage?" "Please be brave; we need to stop the bleeding." "Would you help me dilute this and mix it up?" "Would you like to administer the infusion?"

"Would you help me dilute this and mix it up?"

The caregiver of a child with sickle cell disease asks the nurse how much fluid her child should have each day after the child goes home. In response to the caregiver's question, the nurse would explain that for the child with sickle cell disease, it is best that the child have: 1,500 to 2,000 ml of fluid per day. 1,000 to 1,200 ml of fluid per day. 300 to 800 ml of fluid per day. 2,500 to 3,200 ml of fluid per day.

1,500 to 2,000 ml of fluid per day.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? Contact the health care provider to meet with the parent. Implement strategies to address the child's pain. Ask the parent if he or she has questions about the plan of care. Provide diversional activities for the child.

Implement strategies to address the child's pain.

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? Fluid overload Infection Respiratory distress Pallor

Infection

The nurse is caring for a child with sickle-cell anemia admitted to the pediatric unit. The child reports severe pain and fever. The nurse notes the following laboratory values: white blood cells 18,000/mm3, hemoglobin 6.6 mg/dl (66 g/L), and bilirubin 8 mg/dl (136.83 µmol/L). Which nursing action is priority? Assess the child's temperature. Initiate intravenous access. Administer pain medication. Begin an exchange transfusion.

Initiate intravenous access.

A 13-year-old, diagnosed with beta-thalassemia major is seen in the pediatric clinic. The nurse completes an assessment and notes that the client is below the 10th percentile in height for age. What assumption can the nurse make based on this information? Further assessment of the nutritional status is warranted. This finding is a common manifestation of the client's diagnosis. The client is due for a growth spurt and should catch up in height. The client should be referred for further evaluation.

This finding is a common manifestation of the client's diagnosis.