Perry Ch 43 Practice Questions

A nurse instructs the parent of a child w/ sickle cell anemia about the factors that might precipitate a pain crisis in the child. Which of the following factors identified by the parent as being able to cause a pain crisis indicates a need for further instruction? a) Infection b) Overhydration c) Stress at school d) Cold environment

B Overhydration doesn't cause a crisis.

A condition in which the normal adult Hgb is partly or completely replaced by abnormal Hgb is: a) Aplastic anemia b) Sickle cell anemia c) Thalassemia major d) Iron deficiency anemia

B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult Hgb is replaced by abnormal Hgb.

A nurse is caring for a child w/ sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? a) To decrease potential for infection b) To prevent splenic sequestration c) To prevent sickling of RBCs d) To prevent sickle cell crisis

B Splenic sequestration is a life-threatening situation in children w/ sickle cell anemia.

Which child should the nurse document as being anemic? a) 7 y/o child with a hemoglobin of 11.5 g/dL b) 3 y/o child with a hemoglobin of 12 g/dL c) 14 y/o child with a hemoglobin of 10 g/dL d) 1 y/o child with a hemoglobin of 13 g/dL

C Anemia is a condition in which the number of RBCs, or Hgb concentration, is reduced below the normal values for age (10-11 g/dL).

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include: a) Administering with meals b) Administering between meals c) Injecting deeply into a large muscle d) Massaging injection site for 5 minutes after administration of drug

C Iron dextran is a parenteral form of iron. When administered IM, it must be injected into a large muscle using the Z-track method.

Which of the following analgesics is most effective for a child w/ sickle cell pain crisis? a) Demerol b) Aspirin c) Morphine d) Excedrin

C Morphine is the drug of choice for a child w/ sickle cell crises.

Several blood tests are ordered for a preschool child w/ severe anemia. She is crying and upset because she remembers the venipuncture done at the clinic done at the clinic 2 days ago. The nurse should explain that: a) Venipuncture discomfort is very brief b) Only one venipuncture will be needed c) Topical application of local anesthetic can eliminate venipuncture pain d) Most blood tests on children require only a finger puncture because a small amount of blood is needed

C Preschool children are very concerned about both pain and the loss of blood. When preparing the child for venipuncture, a topical anesthetic will be used to eliminate any pain.

Which statement most accurately described the pathologic changes of sickle cell anemia? a) Sickle-shaped cells carry excess oxygen b) Sickle-shaped cells decrease blood viscosity c) Increased red blood cell destruction occurs d) Decreased red blood cell destruction occurs

C The clinical features of sickle cell anemia are primarily the result of increased RBC destruction and obstruction caused by the sickle-shaped RBCs.

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she or he suggest? a) Iron (ferrous sulfate) drops after age 1 month b) Iron-fortified commercial formula can be used by ages 4 to 6 months c) Iron-fortified infant cereal can be introduced at age 2 months d) Iron-fortified infant cereal can be introduced at approximately 6 months of age

D Breast milk supplies inadequate iron for growth and development after age 5 months.

Which intervention should be implemented after a bone marrow aspiration? a) Ask the child to remain in a supine position b) Place the child in an upright position for 4 hours c) Keep the child NPO for 6 hours d) Administer analgesics as needed for pain

D Children may experience minor discomfort after the procedure, and analgesics should be given as needed.

Which of the following lab tests will be ordered to determine the presence of the HIV antigen in an infant whose parent in HIV+? a) CD4 cell count b) Western blot c) IgG levels d) p24 antigen assay

D Detection of HIV in infants is confirmed by a p24 antigen assay, viral culture of HIV, or polymerase chain reaction.

Which clinical manifestation should the nurse expect when a child w/ SCA experiences an acute vaso-occlusive crisis? a) Circulatory collapse b) Cardiomegaly, systolic murmurs c) Hepatomegaly, intrahepatic cholestasis d) Painful swelling of the hands and feet, painful joints

D A vaso-occlusive crisis is characterized by severe pain in the area of involvement.

Which of the following measures should the nurse teach the parent of a child w/ hemophilia to do first if the child sustains an injury to a joint causing bleeding? a) Give the child a dose of Tylenol b) Immobilize the joint, and elevate the extremity c) Apply heat to the area d) Administer factor per the home-care protocol

D Administration of factor should be the first intervention if home-care transfusions have been initiated.

An accurate description of anemia is: a) Increased blood viscosity b) Depressed hematopoietic system c) Presence of abnormal Hgb d) Decreased oxygen-carrying capacity of blood

D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood.

The nurse is instructing the parent of a child w/ HIV about immunizations. Which of the following should the nurse tell the parent? a) Hep B vaccine will not be given to this child b) Members of the family should be cautioned not to receive the varicella vaccine c) The child will need to have a Western blot test done prior to all immunizations d) Pneumococcal and influenza vaccines are recommended

D Immunizations against childhood illnesses are recommended for children exposed to or infected w/ HIV.

A nurse is doing discharge eduction w/ a parent who has a child w/ beta-thalassemia. The nurse informs the parent that the child is at risk for which of the following conditions? a) Hypertrophy of the thyroid b) Polycythemia vera c) Thrombocytopenia d) Chronic hypoxia and iron overload

D In beta-thalassemia there is increased destruction of RBCs, causing anemia. This results in chronic anemia and hypoxia. The children are treated w/ multiple blood transfusions, which can cause iron overload and damage to major organs.

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

D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension.

Which of the following will be abnormal in a child w/ the diagnosis of hemophilia? a) Platelet count b) Hgb level c) WBC count d) Partial thromboplastin time

D The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.

Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia? a) An elevated hemoglobin level b) A decreased reticulocyte count c) An elevated RBC count d) Red blood cells that are microcytic and hypochromic

D The results of a CBC in children w/ iron deficiency anemia show decreased Hgb levels and microcytic and hypochromic RBCs.

An 8 y/o 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. These manifestations are most suggestive of: a) Air embolism b) Allergic reaction c) Hemolytic reaction d) Circulatory overload

D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain.

Which of the following is the most common opportunistic infection in children infected w/ HIV? a) CMV b) Encephalitis c) Meningitis d) Pneumocystic pnuemonia

D This is the most common opportunistic infection that can occur in HIV-infected children.

A school-age child has sickle cell anemia. The child's parents ask the school nurse regarding the high-risk nature of 4 activities the child is requesting to participate in. Which of the following activities should the nurse advise the parents is most high risk for the child to perform? a) Perform the lead role in the school play b) Play the violin in the school orchestra c) Create an oil painting in art class d) Join the after-school wrestling team

D Wrestling most likely would precipitate a vaso-occlusive crisis.

A young child is admitted to the ED in vaso-occlusive crisis. Which fo the following orders is the highest priority for the nurse to perform? a) Morphine 1mg SQ STAT b) IV D5W 1/4 NS at 90 mL/hr c) Oxygen 2 L/min d) ABGs STAT

B Infusing IV fluids is the priority action.

In which condition are all the formed elements of the blood simultaneously depressed? a) Aplastic anemia b) Sickle cell anemia c) Thalassemia major d) Iron deficiency anemia

A Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed.

Which of the following measures should be implemented for a child w/ von Willebrand disease who has a nosebleed? a) Apply pressure to the nose for at least 10 minutes b) Have the child lie supine and quiet c) Avoid packing of the nostrils d) Encourage the child to swallow frequently

A Applying pressure to the nose may stop the bleeding.

A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? a) A child of Mediterranean descent b) A child of Mexican descent c) A child whose mother has chronic anemia d) A child who has a low intake of iron

A Beta-thalassemia is an inherited recessive disorder that is found primarily in individuals of Mediterranean descent.

Which statement best explain why iron deficiency anemia is common during toddlerhood? a) Milk is a poor source of iron b) Iron cannot be stored during fetal development c) Fetal iron stores are depleted by age 1 month d) Dietary iron cannot be started until age 12 months

A Children between the ages of 12-36 months are at risk for anemia because cow's milk is a major component of their diet, and it is a poor source of iron.

A possible cause of acquired aplastic anemia in children is: a) Drugs b) Injury c) Deficient diet d) Congenital defect

A Drugs such as chemotherapeutic agents and several antibiotics can cause aplastic anemia.

The nurse is caring for a child w/ sickle cell anemia who is schedule to have an exchange transfusion. What information should the nurse teach the family? a) The procedure is done to prevent further sickling during a vaso-occlusive crisis b) The procedure reduces side effects from blood transfusions c) The procedure is a routine treatment for sickle cells crisis d) Once the child's spleen is removed, it is necessary to do exchange transfusions

A Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia.

The most appropriate nursing diagnosis for a child w/ anemia is: a) Activity intolerance r/t generalized weakness b) Decreased cardiac output r/t abnormal Hgb c) Risk for injury r/t depressed sensorium d) Risk for injury r/t dehydration and abnormal Hgb

A The basic pathology in anemia is the decreased oxygen-carrying capacity of the blood. The nurse must assess the child's activity level (response to the physiologic state).

The nurse is taking a health history from a young adult w/ hemophilia. The nurse should ask the client whether he is experiencing any S&S of which of the following chronic illnesses? a) Osteoarthritis b) DM c) Asthma d) Hypothyroidism

A The nurse should assess for S&S of osteoarthritis.

Which of the following activities should a nurse suggest for a client diagnosed w/ hemophilia? Select all that apply. a) Swimming b) Golf c) Hiking d) Fishing e) Soccer

A, B, C, D Children w/ hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as swimming, golf, hiking, and fishing.

A nurse is caring for a child w/ von Willebrand disease. The nurse is aware that which of the following is (are) clinical manifestation(s) of von Willebrand disease? Select all that apply. a) Bleeding of the mucous membranes b) The child bruises easily c) Excessive menstruation d) The child has frequent nosebleeds e) Elevated creatinine levels f) The child has a factor IX deficiency

A, B, C, D These are all manifestations of von Willebrand disease.

The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply. a) Easy bruising occurs b) Gum bleeding occurs c) It's a hereditary bleeding disorder d) Treatment and care are similar to that of hemophilia e) The disorder causes platelets to adhere to damaged endothelium

A, B, C, D, F (Self-explanatory)

A child w/ hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. a) The extremity should be immobilized b) The extremity should be elevated c) Warm moist compresses should be applied to decrease pain d) Passive ROM exercises should be administered to the extremity e) Factor VIII should be adminstered

A, B, E Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization and elevation of the extremity. Hemophilia A is a deficiency in factor VIII, which causes delay in clotting when there is a bleed.

The nurse is caring for a child who is receiving a transfusion of packed RBCs. The nurse is aware that if the child had a hemolytic reaction to the blood, the S&S would include which of the following? Select all that apply. a) Fever b) Rash c) Oliguria d) Hypotension e) Chills

A, C, D Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock.

A 12 y/o boy w/ a history of sickle cell anemia and a diagnosis of vaso-occlusive crisis is being assessed by the admitting nurse in the ED. Which of the following S&S would the nurse expect to see? Select all that apply. a) Priapism b) Pain level of 2/10 c) Hematuria d) Elevated liver enzymes e) Hct 39%

A, C, D Priapism is a symptom seen in males during a vaso-occlusive crisis. Hematuria is a symptoms seen during a vaso-occlusive crisis. Elevated liver enzymes are seen during a vaso-occlusive crisis.

Which of the following factors need(s) to be included in a teaching plan for a child w/ sickle cell anemia? Select all that apply. a) The child needs to be taken to a physician when sick b) The parent should make sure the child sleeps in an air-conditioned room c) Emotional stress should be avoided d) It's important to keep the child well hydrated e) It's important to make sure the child gets adequate nutrition

A, C, D, E (Self-explanatory)

The nurse is reviewing a healthcare provider's prescriptions for a child w/ sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. a) Restrict fluid intake b) Position for comfort c) Avoid strain on painful joints d) Apply nasal oxygen at 2 L/min e) Provide high-calorie, high-protein diet f) Give meperidine, 25mg IV q4h for pain

A, F Oral and IV fluids are an important part of treatment. Meperidine is not recommended for a child w/ SCD because of the risk for nonmeperidine-induced seizures.

The parent of a child w/ hemophilia is asking the nurse what caused the hemophilia. Which is the nurse's best response? a) It is an X-linked dominant disorder b) It is an X-linked recessive disorder c) It is an autosomal dominant disorder d) It is an autosomal recessive disorder

B Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia.

The nurse is instructing the parents of a child w/ iron deficiency anemia regarding the administration of liquid oral iron supplement. Which instruction should the nurse tell the parents? a) Administer the iron at mealtimes b) Administer the iron through a straw c) Mix the iron w/ cereal to administer d) Add the iron to formula for easy administration

B An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because the iron stains the teeth.

A toddler has been diagnosed w/ iron-deficiency anemia. Which of the following information should the nurse educate the parents regarding medication administration? a) Add the iron elixir to his morning bottle b) Have the child drink orange juice right after he takes his medicine c) Administer the medicine right before his meals d) Crush the tablets and mix the medicine w/ his applesauce

B Ascorbic acid (vitamin C) promotes the absorption of iron. Orange juice is high in vitamin C.

A 16 y/o male has hemophilia A. The nurse is assessing the actions performed by the family when administering the teen's medications. Which of the following actions would the nurse expect to see? a) His mother draws up the factor replacement into a syringe b) The young man washes his hands carefully and puts on sterile gloves c) The missing factor is infused every night while the teen sleeps d) Antifibrinolytic medication is taken before each factor infusion

B Before the young man begins the procedure, he should wash his hands carefully and put on sterile gloves.

Which test provides a definitive diagnosis of aplastic anemia? a) CBC w/ differential b) Bone marrow aspiration c) Serum IgG levels d) Basic metabolic panel

B Definitive diagnosis is determined from bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow, fatty marrow.

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? a) Administer antibiotics prophylactically to the child b) Have people wash their hands prior to contact w/ the child c) Assign the same nurses to care for the child each day d) Limit visitors to family members only

B Hand-washing is the best method to prevent the spread of germs and protect the child from infection.

The parent of a 2 y/o who is HIV+ questions the nurse about placing the child in day care. Which of the following is the best response? a) The child should not go to day care until older, because there's a high risk for transmission of the disease b) The child can be admitted to day care without restrictions and should be allowed to participate in all activities c) The child can go to day care but should avoid physical activity d) The child may go to day care, but the parent must inform all the parents at the day care that the child is HIV

B The child can attend day care without any limitations but should not attend w/ a fever.

The nurse is caring for a child w/ aplastic anemia. Which nursing diagnoses are appropriate (Select all that apply)? a) Acute pain r/t vaso-occlusion b) Risk for infection r/t inadequate secondary defenses or immunosuppression c) Ineffective protection r/t thrombocytopenia d) Ineffective tissue perfusion r/t anemia e) Ineffective protection r/t abnormal clotting

B, C, D These are appropriate nursing diagnoses for the nurse planning care for a child w/ aplastic anemia.

As related to inherited disorders, which statement is descriptive of most cases of hemophilia? a) Autosomal dominant disorder causing a deficiency in a factor involved in the blood-clotting reaction b) X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c) X-linked recessive inherited disorder in which a blood-clotting factor is deficient d) Y-linked recessive inherited disorder in which the red blood cells become moon shaped

C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A or classic hemophilia), and factor IX deficiency (hemophilia B or Christmas disease). The disorder involves coagulation factors, not platelets.

When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that: a) They should be given w/ meals b) They should be stopped immediately if nausea and vomiting occur c) Adequate dosage will turn the stools a tarry green color d) Preparation should be allowed to mix w/ saliva and bathe the teeth before swallowing C

C The nurse should prepare the mother for the anticipated change in the child's stools.

A 10 y/o child, diagnosed w/ hemophilia A, is in the ED after experiencing a fall on the school playground. Which of the following laboratory data would the nurse expect to see? a) Leukocyte count 15,000 cells/mm3 b) Platelet count 75,000 cells/mm3 c) Partial prothrombin time (PTT) 90 seconds (normal 60-70 seconds) d) Prothrombin time (PT) 9 sec (normal 11-12.5 sec)

C The nurse would expect the PTT to be prolonged.

A 12-week-gestation African American woman asks her obstetrician's nurse whether her baby could be born w/ sickle cell disease. Which of the following replies is appropriate for the nurse to give? a) It's possible because one out of every 500 African Americans is diagnosed w/ SCD b) If either you or the baby's father has sickle cell anemia, your child may be born w/ the disease c) The baby could only have sickle cell anemia if both you and the baby's father carry a sickle cell gene d) If the child is a boy, he could have sickle cell anemia, but if the child is a girl, she will definitely be healthy

C This statement is correct. The baby could only have sickle cell anemia if both the woman and the baby's father carry a sickle cell gene.

A nurse is caring for a 5 y/o w/ sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. a) Position the child for comfort b) Apply hot packs to painful areas c) Give Demerol 25 mg IV q4h PRN for pain d) Restrict oral fluids e) Apply oxygen per nasal cannula to keep oxygen saturations above 94%

C, D Demerol should be avoided because of the risk of Demerol-induced seizures. The child should receive hydration because abnormal S-shaped RBCs clump.

The nurse is caring for a child w/ SCD. The nurse is aware that the following problems is (are) associated w/ SCD? Select all that apply: a) Polycythemia b) Hemarthrosis c) Aplastic crisis d) Thrombocytopenia e) Splenic sequestration f) Vaso-occlusive crisis

C, E, F Aplastic crisis, splenic sequestration, and vaso-occlusive crisis are all associated w/ SCD.