Sherpath- Immunology Hematology Quiz 1

The nurse is evaluating a family's response to teaching concerning management of sickle cell anemia for their child. Which statement by the family would indicate the need for further teaching? "At the first sign of infection, we need to get the penicillin prescription filled at the pharmacy." "We need to make sure to give our child plenty of fluids to help prevent dehydration and sickling." "We will make sure that our child gets plenty of rest, and we will watch for signs of fatigue our child is playing. "It's important that we try to let our child have as normal of a life as possible, despite some of the precautions that will be necessary."

"At the first sign of infection, we need to get the penicillin prescription filled at the pharmacy." Rationale: Penicillin is recommended prophylactically by age 2 months to prevent pneumococcal sepsis, not just if signs of infection are present. Ensuring adequate hydration is important to prevent dehydration and sickling. Children with sickle cell anemia can fatigue easily and parents should be alert to that possibility and ensure adequate rest periods. Parents should do what they can to allow the child to live as normal a life as possible to support psychological health.

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine therapy. The child's parents ask the nurse what deferoxamine does. What is the most appropriate response by the nurse? "The medication helps prevent iron overload." "The medication provides vitamin supplementation." "The medication stimulates red blood cell production." "The medication helps prevent blood transfusion reactions."

"The medication helps prevent iron overload." Rationale: A common side effect of hypertransfusion therapy is iron overload. Deferoxamine is an iron-chelating drug that binds excess iron and allows it to be excreted by the kidneys. Deferoxamine is not a vitamin supplement; nor does it stimulate red blood cell production or prevent transfusion reactions.

A parent of a child with sickle cell disease tells the nurse she is concerned that her child is becoming addicted to opioids. What is the most appropriate response to her concern? "I hear your concern. Would you like to talk to an addiction specialist?" "Your child is at high risk for becoming behaviorally addicted to opioids." "It doesn't matter whether your child becomes addicted to opioids—the pain must be managed!" "Very few children who are prescribed opioids for severe pain become behaviorally addicted to the drugs."

"Very few children who are prescribed opioids for severe pain become behaviorally addicted to the drugs." Rationale: According to the American Pain Society and National Institutes of Health, very few children who receive opioids for severe pain become behaviorally addicted to the drug. There is no need for the nurse to have the parent speak to an addiction specialist unless the parent has continuing concerns about the issue. Telling the parent that the child is at high risk for becoming behaviorally addicted to opioids is not appropriate. Saying that it doesn't matter if the child becomes addicted because the pain must be treated is not appropriate because it negates the parent's concerns.

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry black color. What is the nurse's best explanation? A symptom of iron deficiency anemia An adverse effect of the iron preparation An indicator of an iron preparation overdose An expected change caused by the iron preparation

An expected change caused by the iron preparation Rationale: An adequate dosage of iron turns the stools a tarry black color. Tarry black stools are not a sign of iron-deficiency anemia. Tarry black stools are not an adverse effect of the iron preparation but an expected effect. Tarry black stools are not an indicator of iron preparation overdose.

What serious complication of sickle cell disease is similar to pneumonia? Sequestration crisis Vasoocclusive crisis Acute chest syndrome Cerebrovascular accident

Acute chest syndrome Rationale: Acute chest syndrome is the presence of new pulmonary infiltrate that presents with symptoms similar to those of pneumonia. Sequestration crisis, or pooling of a large amount of blood, usually in the spleen and infrequently in the liver, is not similar to pneumonia. Vasoocclusive crisis is a painful episode characterized by ischemia and is not similar to pneumonia. Cerebrovascular accident is a stroke and therefore not similar to pneumonia.

What is the most common hematologic disorder of infancy and childhood? Anemia Leukemia Immune thrombocytopenia Disseminated intravascular coagulation

Anemia Rationale: Anemia is the most common hematologic disorder of infancy and childhood. Leukemia is a neoplastic disorder. Immune thrombocytopenia and disseminated intravascular coagulation are hematologic disorders that are less common than anemia.

The nurse is teaching the family of a child diagnosed with iron-deficiency anemia about the proper administration of iron supplements. Which points should the nurse include in the education session? Select all that apply. Administer in two divided doses between meals. Use a straw to administer the iron if it is in liquid form. Administer with citrus fruits or juices to increase absorption. Administer with milk products to alter the taste if taste is an issue. Stop the medication and call the primary care provider if tarry stools are noted.

Administer in two divided doses between meals. Use a straw to administer the iron if it is in liquid form. Administer with citrus fruits or juices to increase absorption. Rationale: The family should be instructed to administer the iron supplement in two divided doses between meals, when free hydrochloric acid is at its greatest levels to aid in absorption. Using a straw for liquid iron is recommended to avoid staining the teeth. Citrus fruits or juices also help increase acidity and therefore absorption of the iron. Milk products bind the iron and interfere with absorption and should not be used with administration of iron. Tarry stools are an expected change with iron supplements, and therefore calling the primary care provider is not necessary.

Which procedure does the nurse recognize as the means of eliminating excess iron in a child with ß-thalassemia major? Antiemetics Splenectomy Chelation therapy Blood transfusions

Chelation therapy Rationale: Chelation therapy minimizes the development of hemosiderosis (iron overload), a complication of blood transfusions. Antiemetics help ease nausea and vomiting. Splenectomy is necessary when severe splenomegaly develops. Blood transfusions are the primary medical management.

What treatment method has greatly improved the prognosis for children with HIV infection? Combination antibiotic therapy Combination analgesic therapy Combination antiemetic therapy Combination antiretroviral therapy

Combination antiretroviral therapy Rationale: Combination antiretroviral therapy has greatly improved the prognosis for children with HIV infection. Combination antibiotic therapy is not used to treat HIV. Combination analgesic therapy has not improved the prognosis for children with HIV infection; nor has combination antiemetic therapy.

Which symptom would the nurse recognize as an acquired immunodeficiency syndrome (AIDS)-defining condition in an American child with human immunodeficiency virus (HIV)? Parotitis Oral candidiasis Hepatosplenomegaly Cytomegalovirus

Cytomegalovirus Rationale: Cytomegalovirus is a defining condition for AIDS in an HIV-infected American child. Parotitis, oral candidiasis, and hepatosplenomegaly are common clinical manifestations of HIV infection in children but not AIDS-defining conditions.

What are the most common clinical manifestations of hemophilia? Select all that apply. Fever Excessive bruising Nausea and vomiting Hemorrhage from any trauma Prolonged bleeding from or in the body

Excessive bruising Hemorrhage from any trauma Prolonged bleeding from or in the body Rationale: The most common clinical manifestations of hemophilia are prolonged bleeding anywhere from or in the body, hemorrhage from any trauma, and excessive bruising. Fever and nausea and vomiting are not common clinical manifestations of hemophilia.

When developing a plan of care for a child diagnosed with anemia, which activity is important for the nurse to complete in order to determine how to minimize tissue oxygen needs? Limit the child's playtime to 30 minutes per session, three or four times a day as tolerated. Encourage the family to do as many of the child's activities of daily living as possible to decrease energy expenditure. Measure the child's vital signs and observe behavior during periods of rest to establish a baseline for nonexertion energy expenditure. Schedule 10- to 15-minute rest periods every hour during the daytime to ensure that the child is receiving adequate rest.

Measure the child's vital signs and observe behavior during periods of rest to establish a baseline for nonexertion energy expenditure. Rationale: It is important that the nurse establish a baseline for nonexertion energy expenditure so that comparisons can be made when the child is active. Limitations on playtime will be determined by comparing nonexertion energy expenditure with energy expenditure during activity; an arbitrary amount of time should not be set. The child should be encouraged to do as many self-care activities as possible. The child may need frequent rest periods, but these should be determined based on the child's tolerance, not scheduled arbitrarily.

Which drug is not recommended for treating pain during sickle cell disease episodes? Morphine Ketorolac Ibuprofen Meperidine

Meperidine Rationale: Meperidine is not recommended, because a metabolite of meperidine (normeperidine) can produce anxiety, tremors, myoclonus, and seizures when it accumulates with repetitive doses. Morphine is used for severe pain. Ketorolac is used to enhance pain management effects. Ibuprofen is useful with the mild pain associated with painful episodes.

Which statement is true regarding human immunodeficiency virus (HIV)-positive children attending schools? Parents or legal guardians have the right to decide whether or not to share HIV status with the school. By law, schools, daycare facilities, and other settings that provide similar services to children must be notified of HIV status. HIV-positive children must receive permission from the school board to participate in contact sports with a high risk for injury. Children diagnosed with human immunodeficiency syndrome are legally unable to attend public schools.

Parents or legal guardians have the right to decide whether or not to share HIV status with the school. Rationale: Parents of children affected with HIV are not required to disclose HIV status to the school. The law does not require disclosure of HIV status to schools. Permission is not required for children with HIV to participate in sports. Children may attend public school if diagnosed with HIV.

Which complete blood count (CBC) test value would the nurse consider outside normal range? Red blood cell (RBC) count 5.0 million/mm 3 White blood cell (WBC) count 12.8 x 10 3 cells/mm 3 Platelet count 430 x 10 3/mm 3 Eosinophils 2.5% of differential WBC count

Platelet count 430 x 10 3/mm 3 Rationale: A normal platelet count is 150 to 400 x 10 3 /mm 3; therefore, 430 x 10 3/mm 3 is abnormal. Normal RBC count is 4.5 to 5.5 million/mm 3; therefore, 5.0 million/mm 3 is in the normal range. A normal WBC count is 4.5 to 13.5 x 10 3 cells/mm 3; therefore, 12.8 x 10 3 cells/mm 3 is in the normal range. Eosinophils generally account for 1% to 3% of the differential WBC count; therefore, 2.5% is in normal range.

What is the primary treatment for hemophilia? Exercise Corticosteroids Pain management Replacement of missing clotting factor

Replacement of missing clotting factor Rationale: Replacement of the missing clotting factor is the primary therapy for hemophilia. Exercise is important but not the primary therapy for hemophilia. Corticosteroids are helpful for hematuria and chronic synovitis but are not the primary therapy for hemophilia. Treatment of pain is important but not the primary therapy for hemophilia.

A nurse suspects that a child receiving a blood transfusion is experiencing an adverse reaction. What is the nurse's priority action? Taking vital signs Stopping the transfusion Diluting the infusing blood Notifying the health care provider

Stopping the transfusion Rationale: Stopping the transfusion, obtaining new tubing, and maintaining a patent IV line with normal saline solution are the priority nursing actions. The nurse should take vital signs and notify the health care provider as appropriate after priority responsibilities have been fulfilled. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused, so stopping the transfusion, rather than diluting the blood, is appropriate.

The nurse suspects that a child is having an adverse reaction to a blood transfusion. What is the nurse's priority action? Notifying the physician of the transfusion reaction Diluting infusing blood with equal amounts of normal saline Taking vital signs and blood pressure and comparing to baseline values Stopping the transfusion and maintaining a patent intravenous line

Stopping the transfusion and maintaining a patent intravenous line. Rationale: The priority nursing action is to stop the transfusion and maintain a patent intravenous line with normal saline and new tubing. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused into the child. The physician should be notified after the blood transfusion is stopped and normal saline is infusing. Vital signs should be assessed after the blood transfusion is stopped and normal saline is infusing. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.

What does the nurse recognize as the most important nursing consideration in the care of a child with sickle cell anemia? Referring the parents and child for genetic counseling Helping the child and family adjust to a short-term disease Teaching caregivers about need for multiple blood transfusions Teaching the parents and child how to recognize signs and symptoms of crisis

Teaching the parents and child how to recognize signs and symptoms of crisis Rationale: Teaching the parents and child how to recognize signs and symptoms of crisis is most important for the well-being and safety of the child. Genetic counseling is important, but teaching the care of the child is a priority. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns. Sickle cell anemia is a long-term, chronic illness. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.

A health care provider informs the nurse that the complete blood count of a child shows shift to the left and instructs the nurse to explain this to the parents of the child. What does the nurse tell them? The child most likely has jaundice. The child most likely has bacterial infection. The child most likely has sickle cell anemia. The child most likely has iron-deficiency anemia.

The child most likely has bacterial infection. Rationale: Shift to the left is the common term used to indicate that there is an abnormal complete blood count. This shows that there are immature neutrophils present in the peripheral blood film, which usually occurs due to increased bone marrow function. One of the reasons for the hyperfunction of bone marrow is bacterial infection. Jaundice is said to be present when serum bilirubin levels increase. In sickle cell anemia, abnormal red blood cells are seen in the blood film, and in iron-deficiency anemia, hematocrit levels decrease.

During a blood transfusion, a child reports mild precordial pain. What is the most appropriate action of the nurse? Administer antihistamine. Transfuse the blood slower. Increase the rate of transfusion. Administer epinephrine immediately.

Transfuse the blood slower. Rationale: During a blood transfusion, it is the responsibility of a nurse to monitor the patient regularly to look for any adverse effects. Precordial pain indicates that the child has circulatory overload, and therefore the nurse should slow down the rate of transfusion. If this does not relieve the symptoms, the nurse should stop the transfusion. Antihistamines are administered prophylactically to a patient who tends to have allergic reactions. If a patient has asthmatic wheezing during a blood transfusion, epinephrine should be administered.

The nurse is caring for a 10-year-old child whose white blood cell count is high. The child asks the nurse about the significance of white blood cells. What is the most appropriate response of the nurse? White blood cells help in phagocytizing bacteria. White blood cells help keep germs from causing infections. White blood cells give immunity against bacterial infections. White blood cells carry oxygen from the lungs to all parts of the body.

White blood cells help keep germs from causing infections. Rationale: It is important for a nurse to avoid using medical jargon when talking to children. He or she should explain medical terms in simple words that a child easily understands. Therefore the most appropriate response of the nurse is to say that white blood cells help keep germs from causing infections. Although it is correct that white blood cells help in phagocytizing bacteria and give immunity against bacterial infections, these sentences contain medical jargon that is difficult for a child to understand. It is the function of red blood cells, not white blood cells, to carry oxygen from the lungs to all parts of the body.

The parents of a child with sickle cell anemia are concerned about subsequent children having the disease. Which response by the nurse is most accurate? "Sickle cell anemia is not inherited." "All siblings will have sickle cell anemia." "There is a 25% chance of a sibling having sickle cell anemia." "There is a 50% chance of a sibling having sickle cell anemia."

"There is a 25% chance of a sibling having sickle cell anemia." Rationale: Sickle cell anemia (SCA) is inherited as an autosomal recessive disorder. In this inheritance pattern there is a 25% chance that each subsequent child will have the disorder. SCA is an inherited hemoglobinopathy. In autosomal recessive disorders there is a chance that 25% of the children will have neither SCA nor the sickle cell trait. There is a chance that 50% of the siblings will have the sickle cell trait.

A nursing student caring for a patient admitted for treatment of a sequestration sickle cell crisis is discussing this type of crisis with the instructor. Which statement by the nursing student indicates proper understanding of this type of crisis? "This type of crisis is characterized by pooling of a large amount of blood in the spleen." "This crisis is a painful episode characterized by ischemia, which causes mild to severe pain." "It is often triggered by a viral infection and is characterized by diminished red blood cell (RBC) production." "Anemia, jaundice, and reticulocytosis occur in this type of crisis because of an accelerated rate of red blood cell destruction."

"This type of crisis is characterized by pooling of a large amount of blood in the spleen." Rationale: Sequestration crisis is pooling of blood in the spleen or liver (infrequently) that leads to decreased blood volume and shock. Vasoocclusive crisis is a painful episode characterized by ischemia which causes mild to severe pain for minutes or days. Aplastic crisis is generally triggered by a viral infection and is characterized by diminished RBC production and may lead to profound anemia. Hyperhemolytic crisis is due to an accelerated rate of RBC destruction and is characterized by anemia, jaundice, and reticulocytosis.

The family of a toddler recently diagnosed with beta-thalassemia asks the nurse what the main treatment is. Which statement by the nurse provides the most appropriate response to the family's question? "It's far too early for that to be determined at this time. It may be years before major issues occur." "Transfusions will be required every 3 to 5 weeks to try to keep the hemoglobin at acceptable levels." "A splenectomy will be done initially to decrease abdominal pressure and to increase the lifespan of the red blood cells." "Medications called iron chelators will be used to help avoid the possibility of iron overload by eliminating excess iron."

"Transfusions will be required every 3 to 5 weeks to try to keep the hemoglobin at acceptable levels." Rationale: The cornerstone of medical management of beta-thalassemia involves transfusions as the cornerstone every 3 to 5 weeks to keep the hemoglobin above 9.5 g/dl. Treatment for beta-thalassemia begins when diagnosis is confirmed. A splenectomy may be necessary in some children but is not initially indicated for medical management. Iron chelators may be necessary because of complications of the transfusions.

What ethnic group has the highest incidence of sickle cell disease? Whites Hispanics Native Americans African Americans

African Americans Rationale: African Americans have the highest incidence of sickle cell disease; Hispanics have the second-highest incidence of sickle cell disease. Native Americans and whites have lower incidences of sickle cell disease than do African Americans and Hispanics.

A 2-month-old formula-fed baby is brought in for a routine checkup. The parent of the baby tells the nurse that a friend has advised her to give fresh cow's milk to the baby instead of formula milk, because it has high nutritional value. What does the nurse tell the parent? Fresh cow's milk is the best source of nutrition for a 2-month-old baby. The mother can start giving cow's milk to her baby at 3 months of age. Cow's milk should be avoided before 12 months of age, because it may cause sickle cell anemia. Cow's milk should be avoided before 12 months of age, because it may cause iron-deficiency anemia.

Cow's milk should be avoided before 12 months of age, because it may cause iron-deficiency anemia. Rationale: It is important for a nurse to educate the parents about appropriate measures to be taken to prevent iron-deficiency anemia. Fresh cow's milk contains a heat-labile protein that can induce gastrointestinal bleeding in children younger than 12 months. It can also cause gastrointestinal mucosal damage in these children, leading to bleeding. Therefore, fresh cow's milk should not be given to children before 12 months of age, because it may cause iron-deficiency anemia due to gastrointestinal bleeding. Sickle cell anemia is not caused by cow's milk; instead it is an inherited genetic disease.

The nurse is teaching a group of parents of children diagnosed with sickle cell anemia. One parent tells the nurse that he or she is so frightened that the child will die and that he or she has heard that certain signs and symptoms can indicate greater likelihood of death if they occur within the first 2 years of life. Which manifestations does the nurse explain can indicate a severe prognosis? Select all that apply. Dactylitis Severe anemia Leukocytosis Painful joints Chronic anemia

Dactylitis Severe anemia Leukocytosis Rationale: Dactylitis, severe anemia, and leukocytosis are all manifestations which indicate a poorer prognosis if they occur before the age of 2 years. Painful joints and chronic anemia are common manifestations of sickle cell anemia.

The nurse is teaching a group of student nurses about the parenteral administration of iron dextran. What instructions does the nurse include in the teaching? Select all that apply. Give a minimum dose of 1 mL intramuscular (IM) at one site to a child. Give a maximum dose of 1 mL IM at one site to a child. Massage the injection site after administration of iron dextran. Do not massage the injection site after administration of iron dextran. Administer it deeply into a large muscle mass using the Z-track technique. Inject the medication into the deltoid muscle of non-dominant arm.

Give a maximum dose of 1 mL IM at one site to a child. Do not massage the injection site after administration of iron dextran. Administer it deeply into a large muscle mass using the Z-track technique. Rationale: It is important for a nurse to know that the maximum dose of iron dextran to be given to a child at one site is 1 mL IM. It should be administered deeply into a large muscle mass using the Z-track technique. The injection site should never be massaged after administration, because doing so increases the risk of skin staining and irritation. To avoid multiple injections, the intravenous route is usually considered.

A child with sickle cell anemia is brought to the hospital with pain in the lower limbs. On examination the child's skin and tongue are pale and the PaO 2 is 98%. What measure should the nurse take to prevent sickling of red blood cells in this patient? Administer oxygen. Give oral analgesics. Give intravenous fluids. Restrict drinking of water.

Give intravenous fluids. Rationale: Prevention of sickling is an important measure in the management of sickle cell crisis. Hydration of the body either through oral or intravenous fluids helps to prevent the sickling phenomenon. The PaO 2 of the patient indicates that oxygen saturation is optimal, and therefore oxygen administration is not required. Analgesics are given to reduce pain; however they cannot prevent sickling. Drinking of water should be encouraged.

A 4-year-old child is prescribed liquid iron for iron-deficiency anemia. What instructions are given to the parents of this child? Select all that apply. Give the iron using a straw. Give the iron using a tablespoon. Brush the child's teeth after administration of iron. Brush the child's teeth before administration of iron. Give iron along with milk or milk products.

Give the iron using a straw. Brush the child's teeth after administration of iron. Rationale: It is important for a nurse to inform the parents that giving iron in liquid form can stain the teeth. Therefore it should be administered using a straw. Brushing the teeth after administration of iron can prevent discoloration of teeth. Iron should not be given using a tablespoon, because it can stain the teeth. Brushing the teeth before liquid iron administration has no effect on the staining of the teeth. Cow's milk contains substances that interfere with iron absorption. Therefore, iron should never be given along with milk or milk products.

Which intervention should be performed first by the nurse during a blood transfusion? Transfuse blood slowly for initial 20% of blood volume. Identify donor and recipient blood types and groups. Save donor blood for recrossmatch with patient's blood. Send the patient's blood and urine sample to the laboratory.

Identify donor and recipient blood types and groups. Rationale: The nurse should first check the identification of the recipient and donor's blood group and type regardless of the blood product being used. This is the first step to ensure a safe blood transfusion without hemolytic reactions. After verifying with another nurse, the blood should be transfused slowly for initial 20% of blood volume. The nurse should obtain vital signs of the patient at frequent intervals and monitor for any reaction in the patient. In case of a reaction, the transfusion should be stopped and donor blood saved to recrossmatch with patient's blood. In addition, with a reaction, the patient's blood and urine samples are sent to the laboratory to detect the presence of hemoglobin.

What is the best way to administer parenteral iron preparations? Injection into the deltoid muscle followed by gentle massage Injection into a large muscle with the use of the Z-track method Injection into a large muscle with the use of the air-lock method Injection into a ventrogluteal muscle followed by massage

Injection into a large muscle with the use of the Z-track method Rationale: The best way to administer parenteral iron preparations is injecting the medication into a large muscle with the use of the Z-track method. Never inject iron into the deltoid muscle. It is not appropriate to massage the site after injection of iron because this may worsen skin staining and irritation. When iron is being injected into the muscle, the Z-track method is preferred over the air-lock method.

Which interventions are included in the management of nosebleeds in children? Select all that apply. Instruct the child to breathe through the mouth. Have the child sit down and tilt the head backward. Insert cotton or wadded tissue into each nostril if bleeding persists. Apply warm compresses to the bridge of the nose if bleeding is persistent. Apply continuous pressure to the nose with thumb and forefinger for at least 10 minutes.

Instruct the child to breathe through the mouth. Insert cotton or wadded tissue into each nostril if bleeding persists. Apply continuous pressure to the nose with thumb and forefinger for at least 10 minutes. Rationale: During a nosebleed, the child should be instructed to breathe through the mouth, cotton or wadded tissue can be inserted into the nostrils to stop bleeding, and continuous pressure using the thumb and forefinger should be applied for at least 10 minutes. The child should be instructed to sit up and lean forward, not tilt the head backward. Ice or cold cloths, not warm compresses, can be used on the bridge of the nose if bleeding persists.

What important factor should the nurse consider when administering iron? Iron should not be given with milk. Iron can be given into a small muscle. Iron may be mixed with yogurt for administration to small children. Iron should be injected deeply into a large muscle mass using an air-lock method.

Iron should not be given with milk. Rationale: Cow's milk contains substances that bind the iron and interfere with absorption. Iron should not be given with milk or milk products such as yogurt. Iron should be given into large muscles to prevent skin staining and irritation. Iron should be injected deeply into a large muscle with the Z-track, not the air-lock, method to prevent skin staining and irritation.

While reviewing the laboratory reports of a patient with hemophilia, the nurse finds that the patient has passed black, tarry stools. What should the nurse interpret from these findings? The patient has increased peristalsis. The patient has gastrointestinal bleeding. The patient is taking calcium supplements. The patient is taking multivitamin supplements.

The patient has gastrointestinal bleeding. Rationale: A patient with hemophilia has black, tarry stools. This indicates that the patient has internal bleeding in the gastrointestinal system. Increased peristaltic movements do not result in black, tarry stools in the patient. Calcium supplements may cause gas or constipation but are not associated with black, tarry stools. A multivitamin tablet can cause allergic reactions such as swelling, tightness, and numbness, but it is not associated with bleeding.