Hematology Practice Questions

The parent of child receiving an oral iron preparation tells the nurse that the child's stools are a tarry black color. The nurse should explain that this is a. a symptom of iron-deficiency anemia b. an adverse effect of the oral iron preparation c. an indicator of overdose d. a normally expected change due to the oral iron preparation

D. A normally expected change due to the oral iron preparation

The nurse has initiated a blood transfusion on a preschool child. The child begins to exhibit signs of a transfusion reaction. Place in order the interventions the nurse should implement sequencing from the highest priority to the lowest. Provide the answer using lowercase letters separated by commas (e.g., a, b, c, d). a. Take the vital signs. b. Stop the transfusion. c. Notify the practitioner. d. Maintain a patent IV line with normal saline

ANS: b, a, d, c If a blood transfusion reaction of any type is suspected, stop the transfusion, take vital signs, maintain a patent IV line with normal saline and new tubing, notify the practitioner, and do not restart the transfusion until the child's condition has been medically evaluated.

The mother of a toddler with sickle cell disease calls the clinic to report that the child has a fever of 101.5 F and has been coughing. Which action would the nurse recommend to the parent? a. Have the child evaluated in the emergency room immediately b. Give Tylenol and recheck temp in one hour c. Have child rest at home as the likely cause is a viral illness d. Give clear liquids and aspirin for fever

ANS: A Children with sickle cell disease are at increased risk for infection due to splenic dysfunction. It is essential to promote early diagnosis and treatment of any potentially infectious process. A fever and cough could indicate acute chest syndrome which requires prompt treatment with IV antibiotics.

The nurse is caring for an 8 year old diagnosed with Idiopathic Thrombocytopenic Purpura (ITP). Which of the following is considered a standard of care? a. Intramuscular injections are avoided b. Oral steroids are given when platelet counts are elevated above 150,000 c. Strict bedrest is required when platelet counts fall below 150,000 d. Iron supplementation is a mainstay of therapy

ANS: A Intramuscular injections are avoided due to risk of bleeding. Steroids are given when platelets are decreased but above 20,000. Below 20,000 requires infusion of IVIG. Although trauma is avoided, strict bedrest is not needed. Iton supplementation is not routine in ITP.

When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia? a. 25% b. 50% c. 75% d. 100%

ANS: A Sickle cell anemia is inherited in an autosomal recessive pattern. If both parents have sickle cell trait (one copy of the sickle cell gene), then for each pregnancy, a 25% chance exists that their child will be affected with sickle cell disease. With each pregnancy, a 50% chance exists that the child will have sickle cell trait. Percentages of 75% and 100% are too high for the children of parents who have sickle cell trait.

The nurse recognizes which of the following as a clinical manifestation of chronic anemia experienced by children with sickle cell disease? a. Excessive weight gain b. Cardiac murmur c. Early sexual maturation d. Ruddy complexion

ANS: B Chronic anemia is characterized by signs and symptoms that reflect that the body has compensated for the ongoing anemia. Symptoms of chronic anemia include growth retardation, cardiac murmur, delayed sexual maturity and hyperbilirubinemia.

The nurse is teaching parents of a toddler diagnosed with iron-deficiency anemia. Which of the following should be included in the education? a. Give the iron supplement with milk b. Give the iron supplement with citrus fruit or juice c. Monitor for episodes of diarrhea d. Give the iron supplement before meals

ANS: B Iron supplements are absorbed best when given between meals and with citric fruit or juice. Effective compliance with iron supplement therapy will result in stools that are tarry green or black and formed.

The nurse is caring for a toddler being evaluated for anemia. Which of the following might the nurse expect to hear when obtaining the child's history? a. The child has been unusually hungry b. The child has been scratching her arms and legs c. The child recently had a growth spurt d. The child has been complaining of pain in the legs

ANS: B The increased red blood cell breakdown seen in some types of anemia can lead to puritis due to the presence of unconjugated bilirubin. Most children with anemia do not experience an increased appetite. The child with anemia will experience growth retardation. Puritis is a more common complaint than pain.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics? a. Are often ordered but not usually needed b. Rarely cause addiction because they are medically indicated c. Are given as a last resort because of the threat of addiction d. Are used only if other measures, such as ice packs, are ineffective

ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild to moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and are given around the clock. Patient-controlled analgesia reinforces the patient's role and responsibility in managing the pain and provides flexibility in dealing with pain. Few, if any, patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vasoocclusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child? (Select all that apply.) a. Finger sticks for blood work instead of venipunctures b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene e. Administration of packed red blood cells

ANS: B, C, D Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding, such as IM injections. The subcutaneous route is substituted for IM injections whenever possible. Venipunctures for blood samples are usually preferred for these children. There is usually less bleeding after the venipuncture than after finger or heel punctures. Neither aspirin nor any aspirin-containing compound should be used. Acetaminophen is a suitable aspirin substitute, especially for controlling mild pain. A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums. Packed red blood cells are not administered. The primary therapy for hemophilia is replacement of the missing clotting factor. The products available are factor VIII concentrates.

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease? (Select all that apply.) a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vasoocclusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

ANS: B, C, E The most important issues to teach the family of a child with sickle cell anemia are to (1) seek early intervention for problems, such as a fever of 38.5° C (101.3° F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. It is not sufficient to advise parents to "force fluids" or "encourage drinking." They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddings. Increased fluids combined with impaired kidney function result in the problem of enuresis. Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting, such as limiting fluids at night. Enuresis is treated as a complication of the disease, such as joint pain or some other symptom, to alleviate parental pressure on the child. Ice should not be used during a vasoocclusive pain crisis because it vasoconstricts and impairs circulation even more.

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? (Select all that apply.) a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sports such as soccer and basketball are not recommended.

A toddler with hemophilia is hospitalized with multiple injuries after falling off a slide. X-rays reveal no bone fractures. When caring for this child, what is the nurse's highest priority? a. Administering platelets as prescribed b. Taking measures to prevent infection c. Frequently assessing the child's level of consciousness d. Discussing a safe play environment for the child

ANS: C A child with hemophilia should be monitored for bleeding sequela after an injury. One of the greatest risks for children with hemophilia is a head injury. Therefore, an critical assessment would be neurological status for evidence of a head bleed.

A 4 year old with sickle cell disease in vaso-occlusive crisis is admitted. The nurse knows that the primary aim of treatment is to: a. Decrease fever b. Prevent spread of infection to other patients c. Provide for hydration, oxygenation and pain management d. Prevent necrosis of ischemic area

ANS: C A child with sickle cell disease in crisis requires methods to reduce red blood cell sickling such as hydration adn oxygenation. In addition, the child will require pharmacological pain management.

The nurse is teaching parents of an infant about the causes of iron-deficiency anemia. Which statement best describes iron-deficiency anemia in infants? a. It is caused by depression of the hematopoietic system. b. It is easily diagnosed because of an infant's emaciated appearance. c. Clinical manifestations are similar regardless of the cause of the anemia. d. Clinical manifestations result from a decreased intake of milk and the preterm addition of solid foods.

ANS: C In iron-deficiency anemia, the child's clinical appearance is a result of the anemia, not the underlying cause. Usually the hematopoietic system is not depressed in iron-deficiency anemia. The bone marrow produces red cells that are smaller and contain less hemoglobin than normal red cells. Children who are iron deficient from drinking excessive quantities of milk are usually pale and overweight. They are receiving sufficient calories, but are deficient in essential nutrients. The clinical manifestations result from decreased intake of iron-fortified solid foods and an excessive intake of milk.

Which statement best describes β-thalassemia major (Cooley anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Sickle cell disease is common in persons of West African descent.

The nurse is recommending how to prevent iron-deficiency anemia in a healthy, term, breastfed infant. Which should be suggested? a. Iron (ferrous sulfate) drops after age 1 month b. Iron-fortified commercial formula by age 4 to 6 months c. Iron-fortified infant cereal by age 2 months d. Iron-fortified infant cereal by age 4 to 6 months

ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. The mother can supplement the breastfeeding with iron-fortified infant cereal. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Providing iron-fortified commercial formula by age 4 to 6 months should be done only if the mother is choosing to discontinue breastfeeding.

The nurse is caring for an 18 month old who is being treated for iron deficiency anemia. The child's parents ask what most likely led to the development of anemia. Which of the following is the nurse's best response? a. "Your child's body is likely breaking down the red blood cells rapidly" b. "Your child is probably not drinking enough milk" c. "Your child's body is probably not producing too many red blood cells" d. "Your child may be drinking too much milk"

ANS: D In this age group, excessive consumption of milk is a primary cause of iron deficiency anemia.

Several complications can occur when a child receives a blood transfusion. Which is an immediate sign or symptom of an air embolus? a. Chills and shaking b. Nausea and vomiting c. Irregular heart rate d. Sudden difficulty in breathing

ANS: D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

You are caring for a school age child with idiopathic thrombocytopenia purpura (ITP). Which of the following would pose the greatest risk for the child? a. Infection b. Ibuprofen c. Steroids d. Trauma

ANS: D The child with ITP demonstrates a low platelet count below 20,000 (normal range:150,000-400,000). Signs of low platelet count include: petichiae, bruising and bleeding. Trauma poses the greatest risk for the child because of the associated bleeding with injury. Ibuprofen is associated with impaired platelet function however it is not a greater risk than trauma.

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. Of what are these manifestations most suggestive? a. Air emboli b. Allergic reaction c. Hemolytic reaction d. Circulatory overload

ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.